Background and importance Efficacy and toxicity are strictly related to serum concentrations of vancomycin. Special care must be considered when treating paediatric patients with this antibiotic. Monitoring and adjusting to protocols and guidelines are key tools for a successful therapy.
Aim and objectives To analyse compliance with the vancomycin dosage protocol in paediatric patients in a third level hospital and to evaluate the impact of pharmacokinetic monitoring on the adequacy of therapeutic levels.
Material and methods A descriptive, observational, retrospective study was conducted from the beginning of the implementation of the vancomycin monitoring programme (January 2017) until August 2020. It included all paediatric patients who had received recommendations for dosage adjustment after determination of vancomycin serum levels. Demographic and clinical variables were collected. Adherence to the initial dosage of the protocol, serum levels at the beginning of the monitoring programme and serum levels at the end of treatment were studied.
Results Data were collected from a total of 133 paediatric patients, 83 males (62.4%). Mean age was calculated for two subpopulations, neonatal patients (<1 month old) with a mean age of 14.5±9.4 days and paediatric patients (>1 month old) with a mean age of 4.4±4.2 years (1 month–14 years). 68.1% of the neonatal patient population were premature, at less than 40 weeks’ gestation. The main services that requested monitoring were the neonatal ICU (40.6%), paediatric ICU (27.8%), neonates (14.3%), paediatrics infectious diseases (8.3%), paediatrics (5.3%) and paediatric oncology (3.8%). Reported treatment diagnoses were: suspected infection (37.2%), sepsis (25.6%), meningitis (10.9%), bacteraemia (7.8%), pneumonia (4.7%), gastrointestinal infection (3.9%), urinary tract infection (1.6%) and other causes (8.5%).
Adherence to the protocol prior to monitoring was 81.2%. Vancomycin levels were within the therapeutic range in 30.8% of cases at the start of monitoring. Following pharmacokinetic recommendations, the values were within the range in 66.2% of cases.
Conclusion and relevance The variability in the paediatric patients in this study showed that, even though most prescriptions were in accordance with the protocol, only 30.8% achieved therapeutic levels. This percentage doubled after the monitoring programme, which highlights the great value of monitoring and personalised dose recommendations, especially recommended in this type of patient.
Conflict of interest No conflict of interest
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