Vancomycin Dosing Assessment in a Tunisian Pediatric Population.

Abstract

Background: Vancomycin is a glycopeptide antibiotic indicated in patients suffering from infections caused by gram-positive bacteria. Therapeutic drug monitoring is crucial because of its high interindividual variability, especially in pediatric populations. However, validated data guiding vancomycin monitoring in pediatric patients are lacking. This study aimed to assess vancomycin plasma concentrations in a Tunisian pediatric population according to patient's age and administration mode.

Methods: A retrospective study was conducted at department of Clinical Pharmacology of National Pharmacovigilance Center. It obtained approval from the Institutional Review Board at Charles Nicolle Hospital in Tunis, Tunisia. Patients included in this study were classified by age. Only vancomycin levels associated with initial doses were evaluated. Continuous and intermittent infusion modes were assessed.

Results: The study included 146 patients. Each age group was separately evaluated. Only 11.8% of initial trough concentrations were within the therapeutic range with an average dosage of 38 mg/kg/d. Using the continuous infusion, 29.5% of initial concentrations reached the therapeutic range with an average vancomycin dose of 44 mg/kg/d. Only 20.5% of plasma concentrations during continuous infusion were supratherapeutic, compared with intermittent infusion (29.4%). Infants and children required higher daily doses to achieve therapeutic range. Lower doses were needed for prematurely born neonates.

Conclusions: Although numerous studies have evaluated vancomycin prescribing practices in pediatric populations, clinical data validating recent recommendations remain lacking. More personalized dosing approaches, including Area Under the Curve-guided monitoring, should be established.