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PKP-002 Continuous infusion vancomycin, a case report
  1. M Suarez Gonzalez1,
  2. C Romero Delgado2,
  3. I Plasencia Garcia1,
  4. S Hernandez Rojas1,
  5. R Mesa Exposito1,
  6. J Merino Alonso1
  1. 1Hospital Universitario Universitario Nuestra Señora de Candelaria, Pharmacy Service, Santa Cruz de Tenerife, Spain
  2. 2Hospital Universitario de Canarias, Pharmacy Service, Santa Cruz de Tenerife, Spain

Abstract

Background Administration of continuous infusion of vancomycin is an alternative to administration of this drug.

Purpose To evaluate the clinical efficacy and incidence of adverse effects with a regimen of vancomycin as a continuous infusion.

Material and methods This was an observational retrospective study of the use of vancomycin in a child diagnosed with ganglioneuroblastoma L2. The information was obtained from the electronic clinical history (SELENE) and the pharmacy service managing software (FARMATOOLS). The programme used for monitoring the pharmacokinetics of drugs is PKS.

Results The patient was a 4-year-old admitted to the paediatric ward of a hospital with febrile neutropenia after receiving the second cycle of chemotherapy (cyclophosphamide+vincristine+adriamycin). Empirical antibiotic therapy was started: vancomycin (15 mg/kg/6 hours) and amikacin (15 mg/kg/24 hours). Vancomycin trough levels obtained during the first 3 days of treatment were very low (2 µg/mL) so a continuous infusion of vancomycin was started. With 60 mg/kg/24 hours of vancomycin, steady state plasma concentration (Css) of 12.1 µg/mL were obtained. Optimal Css levels for vancomycin for prophylaxis treatment are 15–20 µg/mL. Because of persistent fever and worsening of clinical status, the dose was increased to vancomycin 70 mg/kg/day and optimal plasma levels were obtained (17.5 µg/mL). The dose of amikacin was maintained at 15 mg/kg/24 hours, obtaining optimal plasma levels (trough level <1 µg/mL and peak level 30–40 µg/mL). Antibiotic treatment was continued for 7 days and the child had a good response.

Conclusion Administration of continuous infusion vancomycin reached therapeutic levels with good clinical efficacy and no evidence of renal injury, so it is a therapeutic strategy for patients with low levels of drugs in plasma. Moreover, it is a more comfortable administration, with decreased nursing workloads and less manipulation of intravascular catheters. We need more paediatric studies to evaluate the efficacy and safety of these patients using this type of administration.

References and/or acknowledgements Pharmacokinetics manual pharmacy service.

Data sheet of vancomycin and amikacin.

Clinical Report. Evaluation of a paediatric continuous-infusion vancomycin therapy guideline (Susan McKamy, Tempe Chen, Michelle Lee, Peter J Ambrose).

No conflict of interest

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