Pediatric Infectious Disease (Apr 2023)
Vancomycin Therapeutic Drug Monitoring
Abstract
Introduction: Vancomycin is effective against gram-positive bacteria including staphylococcus aureus which are resistant to methicillin. Vancomycin has a narrow therapeutic range and is associated with adverse drug reactions related to iv infusion, nephrotoxicity and ototoxicity. Drug therapeutic level monitoring of this ambiguous drug is important, as a low therapeutic level will not be effective against multidrug-resistant bacteria and a higher drug level may lead to adverse drug reactions mainly renal damage. Hence therapeutic drug monitoring (TDM) of vancomycin becomes very crucial. Objective: To discuss the TDM of vancomycin guidelines. Discussion: This guideline includes indications of TDM, vancomycin target AUC/MIC (Area Under Curve over 24 hours/Minimum Inhibitory Concentration) ratio should be 400–600 mg/hour. In case of a MIC value of >1 mg/L, the guideline recommends changing the therapy. In critically ill patient loading dose can be considered. When conventional intermittent infusion fails to reach adequate therapeutic drug level continuous infusion of vancomycin is recommended. Children above the age of 3 months with suspected MRSA sepsis should receive vancomycin 60–80 mg/kg/day (should not increase >3600 mg/day) in three to four divided doses, considering they have normal renal function. Vancomycin dose should not increase >100 mg/kg/day which is more likely to surpass the threshold level. In the case of obese patients and patients on dialysis therapeutic monitoring and changing the dosage according to that is more important. Conclusion: Vancomycin has a narrow therapeutic index. Low therapeutic levels can lead to treatment failure, and a higher level can lead to adverse effects. This article stresses the need for therapeutic monitoring of vancomycin, especially in children who are critically ill, who have compromised renal function, and those receiving other renal toxic drugs.
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