Background Vancomycin is a concentration-dependent antibiotic usually active on Gram-positive bacteria. An early identification and a monitoring of vancomycin blood concentrations must be made. There are no specific guidelines for the paediatric population.
Purpose Assessment of vancomycin prescriptions and blood-concentration monitoring in a paediatric hospital to propose local recommendations of good practices.
Material and methods This study is a retrospective analysis of computerised vancomycin prescriptions for more than 2 days and associated blood-concentrations monitoring in paediatric patients (excluding ICU and neonatology) from January to December 2016. Demographic data, prescriptions-related parameters (therapeutic indications, dosage and blood concentrations) and additional medical data (renal function, bacteria identification) were extracted from electronic medical patient records and analysed.
Results One hundred and twenty-one prescriptions were reviewed for 87 patients with an average age of 8.9 (0.1–18.8). For 16. 5%, vancomycin was administrated in continuous perfusion and 83.5% in discontinuous perfusion with a mean dose of 43 mg/kg/day. Sixty two per cent (75) prescriptions were for patients with aplasia or receiving chemotherapy with febrile illness; 9.1% (11) were for sepsis; 8.3% (10) for catheter or surgical device-related infections, and 13.2% (16) for other indications. Negative culture results were found for 52.1% (63) prescriptions, and 5% (6) identifications had not been requested. We were not able to calculate glomerular filtration rate (GFR) for 5.8% (7) prescriptions because no determinations of serum creatinine were made. For 6.6% (8) of patients, GFR was below the normal values and all of the prescriptions were stopped. Concerning vancomycin blood-concentration data, 77 (66.6%) monitoring were requested, 85.7% (66) were out of target values but only 38 of this 66 were reassessed (dose adjustment or ceased treatment).
Conclusion The lack of vancomycin blood-concentrations follow-up, dose adjustments and the heterogeneity of prescriptions justify the establishment of local recommendations of good practice. This work will lead to the discussion of new recommendations for vancomycin use with the infectious diseases team.
No conflict of interest
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