EVALUATION OF VANCOMYCIN INITIAL DOSING AND THE RESULTANT TROUGH LEVEL IN PAEDIATRIC PATIENTS

This study aims to examine the vancomycin initial dosing and the resultant trough level in paediatric patients. In this retrospective observational study, all therapeutic drug monitoring (TDM) records of paediatric patients admitted to Sabah Women and Children Hospital (SWACH) from January 2011 to September 2013 were reviewed and 116 patients without renal disease were included in the study. Of the total, 38.8% were neonates, 32.8% were infants and 28.4% were children. The majority of the patients were intensive care patients (69.0%) and the most common clinical indication for vancomycin was sepsis (44.8%). The four initial dosing regimens identified were 40 mg/kg/day (38.8%), 30 mg/kg/day (31.0%), 60 mg/kg/day (25.0%) and 45 mg/kg/day (5.2%). The distribution of initial dosing regimen was significantly different between the three age groups (p 0.001). The proportion of those who achieved the target therapeutic range (10–20 mg/L) was 39.7% whereas the proportions of those who were in sub-therapeutic range ( 10 mg/L) and supra-therapeutic range ( 20 mg/L) were 43.1% and 17.2% respectively. The distribution of trough level was significantly different between those who received ≤40 mg/kg/day and those who received 40 mg/kg/day (p=0.007). The proportions of those who achieved the target therapeutic range (10–20 mg/L) in the 2 dosing groups were 30.9% and 60.0% respectively. In conclusion, the study showed that the initial dosing of 40 mg/kg/day is more likely to achieve the target therapeutic range (10–20 mg/L) compared to the initial dosing of ≤40 mg/kg/day.