High Concentration of Vancomycin in Children with Central Diabetes Insipidus: A Retrospective Case Series

Although the high concentration of vancomycin (VCM) has the potential to cause acute kidney injury and ototoxicity, there were no studies focused on its pharmacokinetics in children with central diabetes insipidus (CDI). We, therefore, evaluated the pharmacokinetic indices of VCM in children with CDI diagnosed and treated at Ehime University Hospital between January 2008 and December 2019. Five patients with CDI administered VCM, were retrospectively reviewed. VCM median initial dose, trough value, clearance (CL) and half-life (t1/2) were 42.0 mg/kg/day (range, 18.8 mg/kg/day-60.0 mg/kg/day), 34.5 mg/L (range, 12.5 mg/L-182 mg/L), 6.54 mL/min (range, 1.57-47.1 mL/min), and 7.11 hr (range, 3.35 hr -38.5 hr), respectively. VCM trough values were high in cases of untreated or inadequately treated CDI. Our results suggest that the decrease in CL and the increase in the volume of distribution caused by CDI and sepsis could result in an extended VCM t1/2 and a higher VCM trough value in patients with CDI.