Pediatric vancomycin dosing: Trends over time and the impact of therapeutic drug monitoring.

IF 2.4 4区 医学 Q3 PHARMACOLOGY & PHARMACY Journal of clinical pharmacology Pub Date : 2015-02-01 Epub Date: 2014-11-07 DOI:10.1002/jcph.402
Alfred H Balch, Jonathan E Constance, Emily A Thorell, Chris Stockmann, Ernest K Korgenski, Sarah C Campbell, Michael G Spigarelli, Catherine M T Sherwin
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引用次数: 21

Abstract

Monitoring of vancomycin trough concentrations is recommended for pediatric patients in the product label and by several professional societies. However, among a network of freestanding children's hospitals vancomycin therapeutic drug monitoring (TDM) practices were reported to be highly variable. In this study, we sought to evaluate whether trends in vancomycin use and TDM changed across a large healthcare delivery system in Utah and Idaho from 2006 to 2012. Children ≤18 years who received ≥2 vancomycin doses were included. Overall, vancomycin TDM was performed during 5,035 (80%) of 6,259 hospital encounters, in which 85,442 doses were administered and 7,935 concentrations were obtained. Across this time period, the median trough concentration increased from 10.9 to 13.7 µg/mL (P < .001), which temporally coincided with recommendations published by the Infectious Disease Society of America that recommend targeting higher trough concentrations. Two or more abnormally low trough concentrations were accompanied by an increase in the dose 75% of the time. Similarly, ≥2 abnormally high trough concentrations were followed by a decrease in the dose 35% of the time. In aggregate, these data suggest that vancomycin TDM is commonly performed among children and the majority of abnormal trough concentrations were associated with an appropriate modification to the dosing regimen.

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儿童万古霉素剂量:随时间的趋势和治疗药物监测的影响。
产品标签和一些专业协会建议儿科患者监测万古霉素谷浓度。然而,据报道,在独立儿童医院网络中,万古霉素治疗药物监测(TDM)的做法变化很大。在这项研究中,我们试图评估从2006年到2012年在犹他州和爱达荷州的大型医疗保健服务系统中万古霉素使用和TDM的趋势是否发生了变化。纳入接受≥2剂万古霉素治疗的≤18岁儿童。总体而言,在6,259次医院就诊中,5,035次(80%)使用万古霉素TDM,其中给予85,442剂,获得7,935种浓度。在这段时间内,中位谷浓度从10.9µg/mL增加到13.7µg/mL (P
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来源期刊
CiteScore
5.10
自引率
3.40%
发文量
176
审稿时长
2 months
期刊介绍: The Journal of Clinical Pharmacology (JCP) is a Human Pharmacology journal designed to provide physicians, pharmacists, research scientists, regulatory scientists, drug developers and academic colleagues a forum to present research in all aspects of Clinical Pharmacology. This includes original research in pharmacokinetics, pharmacogenetics/pharmacogenomics, pharmacometrics, physiologic based pharmacokinetic modeling, drug interactions, therapeutic drug monitoring, regulatory sciences (including unique methods of data analysis), special population studies, drug development, pharmacovigilance, womens’ health, pediatric pharmacology, and pharmacodynamics. Additionally, JCP publishes review articles, commentaries and educational manuscripts. The Journal also serves as an instrument to disseminate Public Policy statements from the American College of Clinical Pharmacology.
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