Initial vancomycin dosing in pediatric oncology and stem cell transplant patients.

Piro CC, Crossno CL, Collier A, Ho R, Koyama T, Frangoul H
J Pediatr Hematol Oncol. 2009 31 (1): 3-7

PMID: 19125078 · DOI:10.1097/MPH.0b013e31818b3520

BACKGROUND - Gram-positive bacteremia is a common infection in pediatric oncology and stem cell transplant (SCT) patients requiring therapy with vancomycin. Optimal dosing of vancomycin in this patient population has not been well established.

METHODS - All pediatric oncology and SCT patients receiving vancomycin between October 2006 and March 2007 were included in this study. Therapeutic levels were defined as levels between 10 and 15 mg/dL and low therapeutic levels were between 5 and 9 mg/dL. Information regarding any recent or concurrent nephrotoxic medications was collected.

RESULTS - Fifty-six patients received 82 courses of vancomycin during the study period. More patients (53.7%) received vancomycin for empiric therapy and 78% had recent or concurrent use of nephrotoxic medications. Using standardized vancomycin dosing guided by a computerized provider order entry system, there were significantly more patients who were in the subtherapeutic range than the supratherapeutic range (P=0.0023). There were also significantly more patients in the low therapeutic than the therapeutic range (P<0.0001). A small number of courses (3.5%) were associated with supratherapeutic levels. There was no association between the concurrent or recent use of nephrotoxic medications and vancomycin levels.

CONCLUSIONS - Pediatric oncology and SCT patients with normal renal function require higher daily vancomycin doses than other pediatric patients.

MeSH Terms (15)

Adolescent Anti-Bacterial Agents Bacteremia Child Child, Preschool Dose-Response Relationship, Drug Humans Infant Leukemia Retrospective Studies Stem Cell Transplantation Transplantation, Homologous Treatment Outcome Vancomycin Young Adult

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