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KMID : 0869620190360020201
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Journal of Korean Society of Hospital Pharmacists
2019 Volume.36 No. 2 p.201 ~ p.211
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A Retrospective Analysis of Vancomycin Pharmacokinetics in Korean Neonates
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Shin Hyun-Jung
Bae Hye-Jung
Kim Moon-Jin
Jung Ae-Hee
Jung Sun-Hoi
Hahn Hyeon-Joo
Jo Yun-Hee
Cho Yoon-Sook
Shin Seung-Han
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Abstract
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Background : Vancomycin is commonly used in neonatal intensive care units (NICU) for the treatment of gram-positive bacterial infections. The aims of this study were to determine the pharmacokinetic parameters of vancomycin in Korean neonates and to assess the percentage of neonates who reached a therapeutic level (trough concentrations of 10 to 20 mg/L) with empirical vancomycin dosing according to the Neofax®.
Methods : This retrospective study reviewed data from 81 neonates admitted to the NICU. The elimination rate constant (Ke), half-life (T1/2), clearance (CL), and the extrapolated trough and peak levels were calculated using first-order pharmacokinetics and a one-compartment model.
Results : Only 21% of the patients achieved therapeutic trough levels (10 to 20 mg/L) with initial dosing according to the Neofax®. Vancomycin clearance was significantly correlated with postmenstrual age (PMA), postnatal age (PNA), weight, and serum creatinine (SCr) level. The recommended dosing regimen in neonates <27 weeks PMA was 10~15 mg/kg q12hr. For neonates in the 27 to 30 week PMA range, the recommended regimen was 15 mg/kg q12hr or 10 mg/kg q8hr for PNA 0~14 days, 10~13 mg/kg q8hr for PNA >14 days with SCr <0.6 mg/dL, and 10~15 mg/kg q12hr for PNA >14 days with SCr 0.6 to <1.5 mg/dL. For neonates in the 30 to 37 week PMA range, the recommended regimen was 10~13 mg/kg q8hr for PNA 0~14 days, 13 mg/kg q8hr or 10 mg/kg q6hr for PNA >14 days with SCr <0.6 mg/dL, and 15 mg/kg q12hr or 10 mg/kg q8hr for PNA >14 days with SCr 0.6 to <1.5 mg/dL. For neonates in the 37 to 44 week PMA range, the recommended regimen was 10~13 mg/kg q8hr for PNA 0~7 days, 13~15 mg/kg q6hr for PNA >7 days with SCr <0.6 mg/dL, and 13 mg/kg q8hr or 10 mg/kg q6hr for PNA >7 days with SCr 0.6 to <1.5 mg/dL. Sixty-three percent (51/81) of the neonates reached a therapeutic level with the new dosing regimen.
Conclusions : The Neofax® vancomycin initial dosing regimen is insufficient for Korean neonates. Further studies are needed to validate the new dosing regimen suitable for achieving target therapeutic levels in Korean neonates.
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KEYWORD
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Vancomycin, Infant, Newborn, Pharmacokinetics
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