Amanda L. Wilkins (Australia)

The Royal Children's Hospital Melbourne General Medicine

Author Of 1 Presentation

INDIVIDUALISED VANCOMYCIN DOSING IN YOUNG INFANTS: PROSPECTIVE CLINICAL VALIDATION OF A NOVEL ONLINE DOSING CALCULATOR

Date
Thu, 12.05.2022
Session Time
10:00 - 11:30
Session Type
Oral Presentations Session
Room
MC 2 HALL
Lecture Time
10:02 - 10:12

Abstract

Backgrounds:

In the majority of young infants, current empiric vancomycin dosing regimens fail to achieve the target concentrations required to treat sepsis. Individualised model-based dosing may improve attainment of therapeutic concentrations by accounting for the factors attributing to interindividual variability. This study assessed the performance of an online dosing calculator (Vanc App) based on a published pharmacokinetic model in achieving target trough vancomycin concentrations of 10 to 20 mg/L at first steady state level (24 to 48 hours) and an AUC24 between 400 and 650 mg/L.h.

Methods

Multicentre study in four Australian tertiary paediatric hospitals over a 17-month period. Infants aged between 0 to 90 days of age with suspected Gram-positive sepsis were eligible. The Vanc App was used to generate a dose based on the infant’s postmenstrual age (PMA), weight, creatinine level and target vancomycin trough concentration.

Results:

Overall, 40 young infants were enrolled, 40% female with a median weight of 2505 (range 700-4460) grams and PMA 37.4 (range 25.7-49) weeks. The median recommended vancomycin dose using Vanc App was 44.5 (range 24 to 79) mg/kg/day. All infants had trough vancomycin concentrations measured at 24 hours and 30 (75%, 95% CI 62%-88%) achieved target trough concentrations, with five each having supratherapeutic (3 between 20-25 mg/L and 2 >25 mg/L) and subtherapeutic concentrations. Target AUC24 was achieved in 32 (80%) for AUC0-24. There were no episodes of vancomycin infusion reaction or nephrotoxicity (defined as creatinine level >2 times baseline).

Conclusions/Learning Points:

Individualised vancomycin dosing using a model-based online calculator resulted in 75% and 80% of young infants achieving target trough and AUC24 targets, respectively at the first steady-state level with no significant vancomycin-related adverse effects.

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Presenter Of 1 Presentation

INDIVIDUALISED VANCOMYCIN DOSING IN YOUNG INFANTS: PROSPECTIVE CLINICAL VALIDATION OF A NOVEL ONLINE DOSING CALCULATOR

Date
Thu, 12.05.2022
Session Time
10:00 - 11:30
Session Type
Oral Presentations Session
Room
MC 2 HALL
Lecture Time
10:02 - 10:12

Abstract

Backgrounds:

In the majority of young infants, current empiric vancomycin dosing regimens fail to achieve the target concentrations required to treat sepsis. Individualised model-based dosing may improve attainment of therapeutic concentrations by accounting for the factors attributing to interindividual variability. This study assessed the performance of an online dosing calculator (Vanc App) based on a published pharmacokinetic model in achieving target trough vancomycin concentrations of 10 to 20 mg/L at first steady state level (24 to 48 hours) and an AUC24 between 400 and 650 mg/L.h.

Methods

Multicentre study in four Australian tertiary paediatric hospitals over a 17-month period. Infants aged between 0 to 90 days of age with suspected Gram-positive sepsis were eligible. The Vanc App was used to generate a dose based on the infant’s postmenstrual age (PMA), weight, creatinine level and target vancomycin trough concentration.

Results:

Overall, 40 young infants were enrolled, 40% female with a median weight of 2505 (range 700-4460) grams and PMA 37.4 (range 25.7-49) weeks. The median recommended vancomycin dose using Vanc App was 44.5 (range 24 to 79) mg/kg/day. All infants had trough vancomycin concentrations measured at 24 hours and 30 (75%, 95% CI 62%-88%) achieved target trough concentrations, with five each having supratherapeutic (3 between 20-25 mg/L and 2 >25 mg/L) and subtherapeutic concentrations. Target AUC24 was achieved in 32 (80%) for AUC0-24. There were no episodes of vancomycin infusion reaction or nephrotoxicity (defined as creatinine level >2 times baseline).

Conclusions/Learning Points:

Individualised vancomycin dosing using a model-based online calculator resulted in 75% and 80% of young infants achieving target trough and AUC24 targets, respectively at the first steady-state level with no significant vancomycin-related adverse effects.

Hide