Vancomycin Dosing Assessment in a Tunisian Pediatric Population: A Database Study

Aim: Vancomycin is a glycopeptide antibiotic indicated in patients suffering from Gram-positive infections. Vancomycin monitoring is crucial due to its high inter-individual variability, especially in pediatric populations. However, there is limited data guiding vancomycin monitoring in pediatric patients compared to adults. This is the first study to assess vancomycin plasma concentrations in a Tunisian pediatric population according to patient’s age and infusion mode. Methods: A retrospective database study was conducted at Clinical Pharmacology department of National Pharmacovigilance Center. Our research obtained approval from the Institutional Review Board at Charles Nicolle Hospital in Tunis, Tunisia.Patients included in this study were classified by age (neonates, infants, children, and adolescents). Only vancomycin levels associated with initial dosing regimens were evaluated. Continuous and intermittent infusion modes were assessed. Results: We included 142 patients. After vancomycin starting dose, 12.1% of trough concentrations were within the therapeutic range (TR) with an average dosage of 38 mg/kg/day. Using the continuous infusion, 29% of initial plasma vancomycin concentrations reached the TR with an average vancomycin dose of 42 mg/kg/day. Only 21% of plasma concentrations during continuous infusion were supratherapeutic, compared to intermittent infusion (28.8%). TR was reached in neonates and infants receiving a continuous infusion at mean rates of 24 mg/kg/d and 46 mg/kg/d, respectively. Neonates and infants receiving an intermittent infusion with mean daily doses of 30 mg/kg and 48 mg/kg, respectively, reached the TR. Conclusion: It is challenging to recommend a single dosing range, mainly due to rapid changes in renal function during growth.