Vancomycin Therapeutic Drug Monitoring in Pediatrics: Trough Monitoring vs. Area Under the Curve

Abstract

Specific Aims: To determine the intrapatient difference in vancomycin dosing requirements (in mg/kg/day) when comparing area under the curve (AUC) against trough level monitoring goals in pediatric patients at Phoenix Children’s Hospital. To determine number of dose changes, correlation of an AUC of 400 mg h/L to trough levels, correlation of trough levels to vancomycin doses, rates of nephrotoxicity, and clinical treatment failure requiring escalation to a more broad-spectrum anti- methicillin-resistant Staphylococcus aureus (MRSA) agent when using trough monitoring compared to AUC dosing. Methods: Retrospective chart review of patients less than 19 years old who received vancomycin therapy for at least 48 hours at PCH between January 1st, 2018 and October 31st, 2020 and had at least one vancomycin peak and trough level measured at steady state within the hospital admission. Main Results: One-hundred pediatric patient charts were reviewed (mean age = 7 years; SD = 5.1; mean weight = 27.1 kg; SD = 19.4; 47% Caucasian). Daily vancomycin exposure was 12.5% lower with AUC monitoring when compared to trough monitoring. An average of two dose changes were required to reach therapeutic steady state. When trough monitoring was utilized, an average trough of 10.5 mg/L was observed as compared to a trough of 8.4 mg/L correlated to an AUC target > 400 mg h/L There were no observed differences in rates of nephrotoxicity and no patients required escalation in anti-MRSA therapy. Conclusions: Vancomycin dosing requirements in these pediatric patients appear to be lower when comparing AUC against trough level monitoring methods.