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| |  Vancomycin Monitoring Uncommon for Pediatric Patients: Presented at ACCP By Crystal Phend WASHINGTON, DC -- September 27, 2005 -- Monitoring of vancomycin concentration peaks in pediatric patients is not the standard of care in most U.S. hospitals, according to findings from a survey presented here at the annual meeting of the American College of Clinical Pharmacology (ACCP) September 12th. Vancomycin is an antibiotic commonly used to treat invasive infections caused by methicillin-resistant Staphylococci. Vancomycin concentration troughs are monitored routinely to ensure levels are high enough to effectively eradicate microorganisms. Concentration peaks, on the other hand, began to be monitored in the 1950s in response to case studies of toxicity to the ear with high levels of the drug. However, the formulation has changed over time and dosing has become more consistent, but limited data are available to support the practice of peak monitoring for vancomycin, said lead author Zeyneb Aydilek, BScPharm, RPh, Clinical Pharmacist, Children's National Medical Center, Washington, DC, United States. To revise guidelines on the practice at her hospital, Aydilek and colleagues surveyed the members of three list serves of pharmacy practitioners in April 2004: the American Society of Health-System Pharmacists Pediatric Clinical Specialists list, pediatrics list of the American College of Clinical Pharmacy, and the Child Health Corporation of America Directors list. Of the 51 e-mail replies received, representing a small minority of list serve members, 12 respondents indicated that their hospital never monitors vancomycin peak concentrations in pediatric patients. The other 39 said their hospitals monitor peaks but typically only under certain circumstances. "The vast majority didn't do them routinely at all," Aydilek said. "The overwhelming response was that it was not routine clinical practice." The types of cases in which vancomycin peak concentrations were monitored routinely were: central nervous system infections (43%), kinetic modeling and endocarditis (9% each), osteomyelitis and renal dysfunction (7% each), neonates (5%), therapeutic failure (4%), and unspecified others (16%). In 74% of cases, peaks were drawn within 1 hour after dose administration. Another 16% were drawn 1 to 2 hours after infusion of vancomycin dose. Based on these results and the "lack of data demonstrating a causal relationship between serum vancomycin concentrations and the drug's efficacy," Aydilek's institution changed its guidelines to not recommend routine peak monitoring in pediatric patients, except for neonates and patients with central nervous system infection, endocarditis or those not showing clinical improvement. "The vast majority of patients do not require that kind of monitoring, and troughs would be sufficient," Aydilek concluded.
[Presentation Title: Theraputic Drug Monitoring of Vancomycin in Pediatrics. Abstract 121]
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