THERAPEUTIC DRUG MONITORING: VANCOMYCIN  DOSING AND PRACTICES IN PEDIATRIC  POPULATION IN ERBIL

Suwar Hassan Mohammed; Kawa Fareq Dizaye; Suha Saeed Azeez

THERAPEUTIC DRUG MONITORING: VANCOMYCIN DOSING AND PRACTICES IN PEDIATRIC POPULATION IN ERBIL

Suwar Hassan Mohammed, Kawa Fareq Dizaye, Suha Saeed Azeez

Abstract

Background: Vancomycin is an essential antimicrobial in pediatric healthcare, but achieving therapeutic serum concentrations is complex due to variable pharmacokinetics in different pediatric age groups. This study aimed to evaluate the effectiveness of empirical vancomycin dosing in achieving target trough concentrations in pediatric patients.

Materials & Methods: This prospective, observational study at Raparin Teaching Hospital for Children, Iraq, included pediatric patients aged one day to 18 years receiving intravenous vancomycin. The primary outcome was the proportion of patients achieving target steady-state trough concentrations of vancomycin based on initial empirical dosing for each age subgroup as per IDSA guidelines. Secondary outcomes included the daily dose requirements by age, time to therapeutic levels, and frequency of subtherapeutic and supratherapeutic troughs.

Results: Of the 60 pediatric patients who received vancomycin therapy for less than 5 days, 23 (38.3%) achieved target trough concentrations with the initial dose. Among them, neonates (21.1%), infants (27.3%), children (50%), and adolescents (60%) demonstrated varied success rates of target trough level attainment. The study also found 67.7% of vancomycin courses resulted in subtherapeutic levels (<10 mg/L). Nephrotoxicity occurred in 10% of treatment courses. The median time to achieve therapeutic levels was 3 days, often requiring dose adjustments.

Conclusion: Achieving target vancomycin trough concentrations in pediatric patients is challenging, with a significant trend towards subtherapeutic levels. This suggests the necessity for age-specific dosing regimens and close therapeutic monitoring to optimize vancomycin therapy in pediatric settings, especially in neonates and infants.

Keywords

Pediatric; Vancomycin; Empirical Dosing; Therapeutic Drug Monitoring; Therapeutic Trough Levels; Target Attainment

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