ORIGINAL ARTICLE

Dose regimen for vancomycin not needing serum peak levels?

W-H Tan¹, N Brown², A W Kelsall¹ and R J McClure¹

¹ Neonatal Intensive Care Unit, The Rosie Hospital, Box 226, Addenbrooke’s NHS Trust, Cambridge CB2 2QQ, UK
² Department of Clinical Microbiology and Public Health Laboratory, Box 236, Addenbrooke’s NHS Trust

Correspondence to:
Correspondence to:
Dr McClure, Neonatal Intensive Care Unit, The Rosie Hospital, Box 226, Addenbrooke’s NHS Trust, Cambridge CB2 2QQ, UK;
rob.mcclure{at}msexc.addenbrookes.anglox.nhs.uk

Aim: To determine the safety, efficacy, and need to measure peak serum vancomycin concentrations in a neonatal population using a standard vancomycin dosage regimen.

Method: A total of 101 infants who were admitted to a regional neonatal intensive care unit and received vancomycin (15 mg/kg every 12 or 18 hours depending on postnatal age) were studied retrospectively. Infants who had been started on vancomycin before they were transferred to the unit were excluded. The proportion of infants was measured whose serum vancomycin concentrations were within a conservative therapeutic range of trough 5–10 mg/l, peak 20–40 mg/l, and a less conservative, but still safe, range of trough 5–12 mg/l, peak 15–60 mg/l.

Results: Trough concentrations of 5–10 mg/l were achieved by 46.5% of infants, and 5–12 mg/l by 55.4%. Peak concentrations of 20–40 mg/l were found in 83.2% of infants, and 15–60 mg/l in 99.0%. Highest peak concentration was 47.2 mg/l. Some 89.4% of infants with trough concentrations of 5–10 mg/l had a peak concentration of 20–40 mg/l.

Conclusions: The vancomycin dosage regimen used in this study produces acceptable therapeutic serum vancomycin concentrations. Peak serum vancomycin concentrations do not need to be measured in neonates using this dosage regimen.

Keywords: vancomycin; drug monitoring; dosage regimen; sepsis; toxicity

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This article has been cited by other articles:

• Crowley, R K, Fitzpatrick, F, Solanki, D, FitzGerald, S, Humphreys, H, Smyth, E G (2007). Vancomycin administration: the impact of multidisciplinary interventions. J. Clin. Pathol. 60: 1155-1159 [Abstract] [Full Text]  
• Jain, S (2003). Role of serum peak levels of vancomycin in neonatal intensive care units. Arch. Dis. Child. Fetal Neonatal Ed. 88: F445-F446 [Full Text]  

eLetters:

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Role of serum peak levels of vancomycin in NICUs

Sunil Jain

Fetal Neonatal Ed. Online, 21 Dec 2002 [Full text]

Authors reply to Dr Sunil's letter

RJ McClure

Fetal Neonatal Ed. Online, 28 Jan 2003 [Full text]