Vancomycin Monitoring in Children: Keys to safe and effective therapy. Narrative review.

Abstract

Vancomycin is the first-line antibiotic for methicillin-resistant Staphylococcus aureus (MRSA) infections and used to treat suspected or confirmed infections caused by other gram-positive bacteria of the Enterococcus genus. However, a narrow therapeutic index requires balancing efficacy with the risk of acute kidney injury (AKI), and large interpatient variability in pharmacokinetics (PK), make vancomycin dosing even more challenging, requiring the use of therapeutic drug monitoring (TDM). Optimizing vancomycin dosing is difficult in children; in 2009 the American Society of Infectious Diseases, the Society of Hospital Pharmacists, and the Society of Pharmacists in Infectious Diseases developed the first consensus for vancomycin therapeutic monitoring that suggested using plasma concentrations between 15 and 20 μg/mL as a surrogate for AUC. / MIC > 400 is considered an ideal measure in Staphylococcus aureus infections, a value that was updated in its latest version in 2020. Most of the available studies analyze therapeutic monitoring in critical patients in isolation until establishing the recommended pediatric dose of 60 mg/kg/day intravenously. There are special groups of pediatric patients in whom the use of vancomycin and its therapeutic monitoring is critical, such as critically ill patients due to sepsis or septic shock, patients with renal failure, and patients with obesity, mainly to avoid nephrotoxicity. Future studies are needed in all populations to address existing gaps with solid evidence on the efficacy of using vancomycin in specific conditions. Next, a narrative review on information collected in databases such as UpToDate, Google Scholar, Medline, ClinicalKey, Scopus, Embase, PubMed; with the objective of describing the most relevant aspects of Vancomycin monitoring in humans.