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Pediatric Drugs

, Volume 21, Issue 4, pp 303–312 | Cite as

Vancomycin Use in a Paediatric Intensive Care Unit of a Tertiary Care Hospital

  • Kannan SridharanEmail author
  • Amal Al-Daylami
  • Reema Ajjawi
  • Husain AM Al Ajooz
Original Research Article

Abstract

Background

Vancomycin is one of the commonly used anti-microbial drugs in intensive care units (ICUs). Guidelines recommend maintaining therapeutic trough levels of vancomycin (10–20 mg/L). The success of achieving the recommended therapeutic concentration of vancomycin is influenced by several factors, and this is even more complex in children, particularly those admitted in the ICU. Hence, we carried out the present study in children admitted in the ICU who were administered vancomycin.

Methods

We carried out a chart review of children admitted in the paediatric ICU unit of a tertiary care hospital over a period of 3 years. Information on their demographic factors, diagnoses, duration of hospital stay, vancomycin treatment (dose, frequency and time of administration) and concomitant drugs, and vancomycin trough levels were retrieved. Descriptive statistics were used for representing the demographic factors, and multivariable logistic regression analyses were carried out to assess the determining factors.

Results

One-hundred and two children were identified, of whom 13 had renal dysfunction. Two-hundred and fifty-two vancomycin trough levels were available, of which only 25% were observed in the recommended range (10–20 mg/L) amongst patients without any renal dysfunction and 22% amongst patients with renal dysfunction. Vancomycin was administered intravenously at an average [standard deviation (SD)] dose (mg/dose) of 13 (3.9) mostly either thrice or four times daily. Even in patients receiving vancomycin as a definitive therapy, only 40.9% achieved the recommended trough levels. Lower trough levels were associated with an increased risk of mortality. Nearly 4% of the levels were above 20 mg/L (toxic range). Seven children were suspected to have acute kidney injury (AKI) during the course of therapy where the cumulative vancomycin dose and mortality rate was higher. Only one serum vancomycin level during augmented renal clearance was observed in the recommended range. All the patients received at least one concomitant drug that either had nephrotoxic potential or predominant renal elimination, and use of a greater number of such drugs was associated with an increased risk of AKI.

Conclusion

The current vancomycin dosing strategy is ineffective in achieving therapeutic trough levels in children admitted to the ICU. Sub-therapeutic vancomycin trough levels significantly increase the risk of mortality.

Notes

Acknowledgements

We thank the Research Technical Support Team in the Ministry of Health, Bahrain, for their ethics approval for carrying out this study.

Compliance with Ethical Standards

Funding

No funding was obtained.

Conflict of interest

The authors, K. Sridharan, A. Al-Daylami, R. Ajjawi and H.A.M. Al Ajooz, do not have any conflicts of interest to declare.

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Pharmacology and Therapeutics, College of Medicine and Medical SciencesArabian Gulf UniversityManamaBahrain
  2. 2.Department of Paediatrics, College of Medicine and Medical SciencesArabian Gulf UniversityManamaBahrain
  3. 3.Paediatric Intensive Care UnitSalmaniya Medical Complex, Ministry of HealthManamaBahrain

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