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Vancomycin Dosage and Its Association with Clinical Outcomes in Pediatric Patients with Gram-Positive Bacterial Infections

Authors Shin S, Jung HJ, Jeon SM, Park YJ, Chae JW, Yun HY

Received 5 January 2020

Accepted for publication 7 May 2020

Published 29 June 2020 Volume 2020:13 Pages 685—695


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Kent Rondeau

Sooyoung Shin,1,2 Hyun Joo Jung,3 Sang-Min Jeon,1 Young-Joon Park,1 Jung-Woo Chae,2 Hwi-Yeol Yun2

1College of Pharmacy, Ajou University, Suwon, Gyeonggi-do 16499, Republic of Korea; 2College of Pharmacy, Chungnam National University, Daejeon 34134, Republic of Korea; 3Department of Pediatrics, Ajou University Hospital, Suwon, Gyeonggi-do 16499, Republic of Korea

Correspondence: Hwi-Yeol Yun; Jung-Woo Chae
Tel +82 42 821 5941; +82 42 821 5929
Fax +82 42 823 6566

Aim: The aim of this study was to evaluate whether vancomycin trough concentrations at initial steady state are associated with clinical and microbiological outcomes along with vancomycin-related nephrotoxicity in pediatric patients with Gram-positive bacterial (GPB) infections.
Methods: A retrospective cohort study of pediatric patients who received vancomycin for ≥ 72 hours during 2008– 2016 was conducted. Study patients were divided into three cohorts in accordance with their first trough levels at steady state: < 5 mg/L (lower-trough), 5– 10 mg/L (low-trough), and > 10 mg/L (high-trough; reference) cohorts.
Results: Of the 201 patients eligible for study inclusion, 60 patients in the lower- and low-trough cohorts, respectively, were idect 3ntified via propensity score matching and analyzed against 30 high-trough patients in each comparison pair (neonates were excluded due to small sample size). Lower-trough patients were at a greater risk for prolonged therapy, retreatment, and dose adjustment than high-trough patients. Final steady-state troughs remained substantially lower in both the lower- and low-trough cohorts (p< 0.001 and p=0.005, respectively), despite greater dose up-titration in the lower-trough cohort and percent change in daily dose in both the lower- and low-trough cohorts than in the high-trough cohort (p< 0.001 for all). Clinical cure and death risk, along with the risks of isolation of resistant strains and renal events, were not significantly different between cohorts in both comparison pairs.
Conclusion: Vancomycin troughs of < 5 mg/L at initial steady state were associated with significantly compromised clinical outcomes in terms of risk of therapy prolongation, retreatment, and aggressive dose up-titration, compared to > 10 mg/L troughs in pediatric patients with GPB infections.

Keywords: pediatrics, vancomycin, drug monitoring, Gram-positive bacterial infection

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