An evaluation of theoretical loading doses in pediatric patients receiving vancomycin

Purpose: Based on the 2009 ASHP/IDSA/SIDP guidelines for vancomycin use and monitoring, evidence suggests that adult patients with serious MRSA infections should be considered for a loading dose (25-30 mg/kg per actual body weight). However, there is no current evidence regarding the use of loading doses in pediatric patients.  Therefore, the purpose of this study is to predict the pharmacokinetics in pediatric patients at an academic medical center to assess if giving a loading dose of vancomycin at the initiation of therapy would correlate to therapeutic levels following the initial regimen prescribed, rather than necessitating a regimen adjustment later in therapy as is commonly the case.

Methods: A retrospective chart review from January to December 2011 was conducted in pediatric patients ages 1 to 17 who received vancomycin at the Georgia Health Sciences Children’s Medical Center and had complete sets of levels (both peaks and troughs). We calculated patient-specific parameters based on the peak and trough levels, and then calculated how each patient’s levels would have been affected by administration of various loading doses (20 mg/kg, 25 mg/kg, 30 mg/kg, and 35 mg/kg).

Results: Data was collected in 63 patients within 77 separate admissions and yielded 90 complete sets of vancomycin levels. 

Conclusion: Analysis is currently under way with results and conclusions still pending.