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Recommended doses of endovenous vancomycin are insufficient to achieve therapeutic concentrations in paediatric patients
  1. Irene Aguilo Lafarga1,
  2. María Pérez Moreno1,
  3. Elena Herranz Bayo1,
  4. Miriam Merchante Andreu2,
  5. Rafael Huarte Lacunza1
  1. 1Pharmacy Service, Hospital Universitario Miguel Servet, Zaragoza, Aragon, Spain
  2. 2Pharmacy Service, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Aragon, Spain
  1. Correspondence to Mrs Irene Aguilo Lafarga, Hospital Universitario Miguel Servet, Zaragoza 50009, Spain; ireneaguilolafarga{at}


Objectives Vancomycin therapeutic drug monitoring is challenging, especially in the paediatric population where evidence is scarce. The main objective of this study was to analyse the achievement of therapeutic concentrations of vancomycin in paediatric patients and to evaluate the current monitoring method (trough levels), doses used, and the time required to achieve target concentrations.

Methods Paediatric patients on treatment and monitored with vancomycin from November 2019 to December 2021 were included. Those with only one determination of serum vancomycin concentration were excluded. Demographic variables, analytical and microbiological parameters and toxicity data were collected. Pharmacokinetic parameters were assessed at baseline and during treatment.

Results 225 patients (40.9% female; 108 neonates, 49 infants and 68 children or adolescents) were included in the study. The main indications for vancomycin treatment were sepsis (33.9%) and fever of unknown origin (29.3%). Microbiological cultures were positive in 71.1%, mostly with Gram-positive bacteria (60.4%). Therapeutic levels of vancomycin were reached in only 20.1% of the participants in the first determination. After pharmacokinetic monitoring, 81.7% of patients reached therapeutic concentrations, requiring a 23% increase in the initial dose, a 2-day lag time and 1–2 dosage adjustments until the therapeutic concentration was reached. Of the total patients, 13 developed nephrotoxicity, nine neutropenia and one patient developed red man syndrome.

Conclusions In our sample of paediatric patients, the recommended doses of vancomycin were insufficient to achieve therapeutic concentrations. Revision of the recommendations and/or a change in the method of pharmacokinetic monitoring is crucial to optimise treatment in this population.

  • Drug Monitoring
  • Pharmacokinetics
  • Administration, Intravenous
  • Safety
  • Microbiology

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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