Therapeutic Drug Monitoring of Vancomycin in Pediatric Patients: Defining a Therapeutic Drug Window

Abstract

Background Methicillin-resistant Staphylococcus aureus (MRSA) infections among children are escalating annually. Vancomycin stands as the frontline therapeutic agent against MRSA infections. However, determining the therapeutic window for vancomycin in pediatric patients remains a challenge. Methods This retrospective study collected data from hospitalized children aged 1 month to 18 years, who underwent routine therapeutic drug monitoring for vancomycin. We analyzed the distribution patterns of vancomycin concentrations in these patients. Factors influencing clinical outcomes and adverse reaction (nephrotoxicity) were investigated. ROC analysis was used to establish the therapeutic window for vancomycin in pediatric patients. Results A comprehensive dataset encompassing 183 pediatric patients with 330 samples was analyzed. The mean trough concentration (C_min) of vancomycin was 7.6 ± 5.5 mg/L. 74.3% of patients exhibited concentrations below the conventionally recommended therapeutic window of 10–20 mg/L. Patients responding positively to treatment exhibited significantly higher C_min values (8.4 ± 5.7 mg/L) compared to those with treatment failure (5.9 ± 4.4 mg/L, P = 0.006). Similarly, patients who developed nephrotoxicity had significantly elevated C_min levels (17.8 ± 5.3 mg/L) compared to those without nephrotoxicity (6.4 ± 3.9 mg/L, P < 0.001). Both univariate and multivariate logistic regressions revealed that the C_min of vancomycin was the predictor of both clinical outcomes and adverse reaction. Furthermore, receiver operating characteristic curve analysis pinpointed that C_min of vancomycin with 5.9 mg/L and 14.8 mg/L associated with clinical effectiveness and safety, respectively. Conclusion Referring to the therapeutic window of adults, vancomycin underexposure in pediatrics is serious extremely. Based on our findings, we propose a revised therapeutic window of 5.9–14.8 mg/L for vancomycin in pediatric patients, which could aid in optimizing treatment outcomes and minimizing adverse effects.