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Vancomycin nomograms in children admitted to an intensive care unit

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Abstract

Background

Vancomycin is one of the commonly used antimicrobial drugs in children admitted to intensive care units (ICUs). Population-specific pharmacokinetic (PK) assessment and nomogram development is essential for individualizing therapy. We attempted to elucidate PK parameters for vancomycin using a Bayesian approach and develop nomograms in our critically ill children.

Methods

The study was conducted as a retrospective chart review of children admitted to the ICU of Salmaniya Medical Hospital, Kingdom of Bahrain. Details about vancomycin regimen and initial serum creatinine were extracted from the hospital records. Using validated software, Bayesian PK parameters were established at first dose and at steady state for vancomycin. We also evaluated the PK parameters using a manual method by Le et al, where vancomycin clearance was estimated as follows: CL (L/h) = 0.248 * body weight (kg)0.75 * (0.48/serum creatinine)0.361 * [ln (age)/7.8]0.995. Multiple linear regression models were developed for area under the concentration–time curve over 24 h (AUC0–24). Logistic regression analysis was carried out to assess the probability of achieving an AUC0–24> 400 mg-h/L in the study population.

Results

Twenty samples were available for analysis of first-dose PK and 66 for steady-state assessment. The Bayesian method outperformed manual calculation, which estimated PK parameters that were biologically implausible values for elimination half-life and clearance. We observed a strong correlation between vancomycin trough concentrations and AUC0–24. Nomograms for predicting the AUC0–24 with certain independent variables were developed.

Conclusion

It is feasible to employ Bayesian PK in clinical practice, which could be more useful than monitoring vancomycin regimens based only on the trough concentrations. Population-specific nomograms should be developed and validated for vancomycin rather than tailoring the dosing regimen based on the evidence from other populations.

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Acknowledgements

We thank the Research Technical Support Team, Ministry of Health for ethics approval and continued oversight of this project.

Author information

Correspondence to Kannan Sridharan.

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Conflict of interest

The authors do not have any conflicts of interest.

Funding

None.

Ethical approval

Obtained from the institutional ethics committees of the pediatric ICU of the Salmaniya Medical Complex, Kingdom of Bahrain.

Informed consent

Deemed unnecessary due to the retrospective nature of the data.

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Daylami, A.A., Sridharan, K. & Qader, A.M. Vancomycin nomograms in children admitted to an intensive care unit. Drugs Ther Perspect (2020). https://doi.org/10.1007/s40267-020-00708-y

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