{"id":3448,"date":"2018-12-19T15:50:15","date_gmt":"2018-12-19T05:50:15","guid":{"rendered":"https:\/\/doseme-rx.com\/?p=3448"},"modified":"2021-04-13T17:09:33","modified_gmt":"2021-04-13T07:09:33","slug":"dosing-pediatrics","status":"publish","type":"post","link":"https:\/\/doseme-rx.com\/de\/vancomycin\/articles\/dosing-pediatrics","title":{"rendered":"Vancomycin Dosing in Pediatrics"},"content":{"rendered":"\n<p><strong>Note: The new&nbsp;<a href=\"https:\/\/doseme-rx.com\/news\/20200401-vancomycin-dosing-guidelines-2020-clinical-summary\">vancomycin dosing guidelines<\/a>&nbsp;have been officially released. Learn what&#8217;s changed and how they&#8217;ll impact you by reading our guide to the&nbsp;<a href=\"https:\/\/doseme-rx.com\/news\/20200330-vancomycin-dosing-guidelines-what-to-know\">new vancomycin dosing changes&nbsp;here<\/a>.<\/strong><\/p>\n\n\n\n<p><span style=\"font-weight: 400;\">Vancomycin is a commonly prescribed antibiotic used to treat children and adults with serious infections. Here we review some of the most common indications for vancomycin use and important safety considerations for health practitioners using this drug in pediatric patients. We discuss dosing guidelines, monitoring parameters, and vancomycin\u2019s pharmacokinetic and pharmacodynamics properties.<\/span><\/p>\n\n\n\n<h2 class=\"wp-block-heading\">What are Vancomycin\u2019s Uses and Mechanism of Action?<\/h2>\n\n\n\n<p><span style=\"font-weight: 400;\">Vancomycin is a broad spectrum glycopeptide antibiotic commonly prescribed for infections caused by gram-positive bacteria.<sup>[1]<\/sup> Most studies establishing its safety and efficacy were conducted in patients over 18 years of age, although vancomycin is commonly used in the treatment of pediatric patients presenting with infections such as:<\/span><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><span style=\"font-weight: 400;\"> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<\/span> <span style=\"font-weight: 400;\">pneumonia<\/span><\/li><li><span style=\"font-weight: 400;\"> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<\/span> <span style=\"font-weight: 400;\">pleural empyema<\/span><\/li><li><span style=\"font-weight: 400;\"> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<\/span> <span style=\"font-weight: 400;\">infective endocarditis<\/span><\/li><li><span style=\"font-weight: 400;\"> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<\/span> <span style=\"font-weight: 400;\">colitis associated with Clostridium difficile<\/span><\/li><li><span style=\"font-weight: 400;\"> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<\/span> <span style=\"font-weight: 400;\">enterocolitis<\/span><\/li><li><span style=\"font-weight: 400;\"> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<\/span> <span style=\"font-weight: 400;\">cellulitis<\/span><\/li><li><span style=\"font-weight: 400;\"> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<\/span> <span style=\"font-weight: 400;\">meningitis<\/span><\/li><li><span style=\"font-weight: 400;\"> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<\/span> <span style=\"font-weight: 400;\">bacteremia<\/span><\/li><li><span style=\"font-weight: 400;\"> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<\/span> <span style=\"font-weight: 400;\">sepsis<\/span><\/li><\/ul>\n\n\n\n<p><span style=\"font-weight: 400;\">Due to the serious nature of these infections, vancomycin is often chosen empirically to initiate treatment prior to pathogen identification.<sup>[2]<\/sup> It can also be brought on board to broaden the antimicrobial spectrum when other agents are ineffective or if the causative bacteria are found to be resistant to other medications. Vancomycin exhibits antibacterial activity by disrupting the peptide structure of the bacterial cell wall during the synthesis process.<sup>[3]<\/sup> <\/span><\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img decoding=\"async\" width=\"1024\" height=\"770\" src=\"https:\/\/doseme-rx.com\/wp-content\/uploads\/2018\/12\/Vanc-ped-blog-mecaction-1024x770.jpg\" alt=\"vancomycin mechanism of action\" class=\"wp-image-3450\" srcset=\"https:\/\/doseme-rx.com\/wp-content\/uploads\/2018\/12\/Vanc-ped-blog-mecaction-1024x770.jpg 1024w, https:\/\/doseme-rx.com\/wp-content\/uploads\/2018\/12\/Vanc-ped-blog-mecaction-300x226.jpg 300w, https:\/\/doseme-rx.com\/wp-content\/uploads\/2018\/12\/Vanc-ped-blog-mecaction-768x578.jpg 768w, https:\/\/doseme-rx.com\/wp-content\/uploads\/2018\/12\/Vanc-ped-blog-mecaction.jpg 1407w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/figure><\/div>\n\n\n\n<p><em><span style=\"font-weight: 400;\"><b>Figure 1. Vancomycin Mechanism of Action<\/b><\/span><\/em><\/p>\n\n\n\n<p><span style=\"font-weight: 400;\">Source: <\/span><a href=\"https:\/\/www.mpimf-heidelberg.mpg.de\/gruppen\/cytochrome\/glykopeptide\"><span style=\"font-weight: 400;\">https:\/\/www.mpimf-heidelberg.mpg.de\/gruppen\/cytochrome\/glykopeptide<\/span><\/a><\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Vancomycin Pediatric Dosing<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span style=\"font-weight: 400;\">Initial Dose<\/span><\/h3>\n\n\n\n<p><span style=\"font-weight: 400;\">Vancomycin doses are calculated using the patient\u2019s total body weight.<sup>[4]<\/sup> For children one month to six years of age the suggested empiric vancomycin pediatric dose is 40 mg\/kg\/day divided into four doses given every six hours.<sup>[5]<\/sup> For those aged seven to 18 years old the recommended vancomycin pediatric dose is 40 mg\/kg\/day divided into three doses given every eight hours. If the patient is immunocompromised or suspected to have osteomyelitis, an infection of the central nervous system (CNS), or an infection with methicillin-resistant staphylococcus aureus (MRSA), the empiric dose is 60 mg\/kg\/day divided into four doses given every six hours.<sup>[6]<\/sup> No more than two grams should be administered per dose and the maximum total daily dose recommended for both children and adults is six grams. Dosing calculators are available in clinical references and online to assist prescribers in calculating the appropriate patient dose.<\/span><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span style=\"font-weight: 400;\">Adjustments<\/span><\/h3>\n\n\n\n<p><span style=\"font-weight: 400;\">Pediatric vancomycin dosing adjustments are based on two factors: pathogen sensitivity and serum trough levels. If a culture is performed, the minimum inhibitory concentration (MIC) can be determined and used to guide trough levels. If this information is not available a trough concentration of 10-15 mcg\/mL is recommended for most infections.<sup>[7]<\/sup> If the infection involves the CNS or bone or is hospital acquired or caused by MRSA a trough of 15-20 mcg\/mL should be targeted.<\/span><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span style=\"font-weight: 400;\">Is a Vancomycin Loading Dose Needed?<\/span><\/h3>\n\n\n\n<p><span style=\"font-weight: 400;\">Based on infection type and severity a loading dose may be given to ensure that vancomycin levels rapidly achieve therapeutic plasma concentrations. The vancomycin loading dose is a large dose given once at the onset of therapy to rapidly achieve a therapeutic drug concentration in the body.<sup>[8]<\/sup><\/span><span style=\"font-weight: 400;\"><sup>[9]<\/sup><\/span><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span style=\"font-weight: 400;\">Pediatric Vancomcyin Dosing Studies<\/span><\/h3>\n\n\n\n<p><span style=\"font-weight: 400;\">Although vancomycin dosing guidelines suggest beginning treatment with a vancomycin pediatric dose of 40-60 mg\/kg\/day, recent studies suggest this may be too low a starting dose in some situations:<\/span><\/p>\n\n\n\n<p><span style=\"font-weight: 400;\">One of the most common pathogens vancomycin is used to treat is MRSA. A pediatric modeling study estimated the value for the 24-hour area under the curve (AUC<\/span><span style=\"font-weight: 400;\">24<\/span><span style=\"font-weight: 400;\">) divided by the MIC for children receiving doses of 40 mg\/kg\/day or 60 mg\/kg\/day.<\/span><span style=\"font-weight: 400;\"><sup>[6]<\/sup><\/span><span style=\"font-weight: 400;\"> This value correlates to patient outcome and a value greater than 400 is associated with a better prognosis. Calculating the AUC<\/span><span style=\"font-weight: 400;\">24<\/span><span style=\"font-weight: 400;\">\/MIC for a dose of 40 mg\/kg\/day predicted a value less than 400 while calculating the AUC<\/span><span style=\"font-weight: 400;\">24<\/span><span style=\"font-weight: 400;\">\/MIC for a 60 mg\/kg\/day dose resulted in a value greater than 400. As an AUC<\/span><span style=\"font-weight: 400;\">24<\/span><span style=\"font-weight: 400;\">\/MIC of more than 400 is associated with better outcomes in adults, the authors concluded that the pediatric doses recommended by current guidelines may be insufficient in children with suspected or confirmed MRSA infections.<sup>[7]<\/sup><\/span><\/p>\n\n\n\n<p><span style=\"font-weight: 400;\">A chart review of pediatric patients indicated the current recommended doses of 40-60 mg\/kg\/day are insufficient to achieve the target trough level of 10-20 ng\/mL.<sup>[10]<\/sup> Serum vancomycin trough levels are required to ensure treatment goals are being met.<\/span><\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Vancomycin Pediatric Dose Administration<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span style=\"font-weight: 400;\">Route<\/span><\/h3>\n\n\n\n<p><span style=\"font-weight: 400;\">Vancomycin is normally administered intravenously (IV) due to low oral bioavailability.<sup>[11]<\/sup> Occasionally the oral or rectal routes are used for gastrointestinal infections.<sup>[1]<\/sup><\/span><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span style=\"font-weight: 400;\">Rate<\/span><\/h3>\n\n\n\n<p><span style=\"font-weight: 400;\">Vancomycin pediatric doses are given every 6 to 12 hours.<sup>[12]<\/sup> If other antibiotics are being given simultaneously, administration should be timed to avoid potential drug interactions or incompatibilities. A standard infusion rate of 1 g over 60 minutes is commonly used and the infusion duration varies based on the quantity of drug required. The infusion rate should not be increased above this rate due to the risk of developing red man syndrome, an infusion-related reaction that causes an erythematous rash to develop on the upper body and face.<sup>[13]<\/sup> The administration interval for vancomycin may need to be adjusted based on the patient\u2019s renal function.<sup>[5]<\/sup><\/span><\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Vancomycin&nbsp;Pediatric&nbsp;IV Dosing Safety Considerations<\/h2>\n\n\n\n<p><span style=\"font-weight: 400;\">Vancomycin is dosed to achieve a goal trough level that is determined by the infection type. In children it may be necessary to monitor troughs more frequently than in adults to ensure the patient receives the appropriate dose.<sup>[1]<\/sup><\/span><span style=\"font-weight: 400;\"> Moreover, as the vancomycin pediatric dose is calculated using total body weight it is critical that prescribers take the time to ensure an accurate body weight is obtained.<\/span><\/p>\n\n\n\n<p><span style=\"font-weight: 400;\">Concomitant use of vancomycin and anesthetic agents in children has been associated with histamine-mediated reactions characterized by erythema and flushing.<\/span><sup>[1]<\/sup><span style=\"font-weight: 400;\">&nbsp;The prescribing information instructs healthcare professionals to administer vancomycin at least 60 minutes prior to the anesthetic to decrease the chance that this will occur.<\/span><\/p>\n\n\n\n<p><span style=\"font-weight: 400;\">Nephrotoxicity is an important safety concern in both adult and pediatric patients treated with vancomycin. One retrospective study of 167 patients found that this side effect occurred in 14% of vancomycin treated patients.<sup>[14][15][16][17][18]<\/sup> Numerous publications indicate that an intensive care unit admission or critical illness and the concomitant administration of other nephrotoxic medications increases the risk of acute kidney injury.<\/span><sup>[15][16][17]&nbsp;<\/sup>&nbsp;<span style=\"font-weight: 400;\">Evidence on whether a trough level of greater than 15 ng\/mL is associated with an increased risk of nephrotoxicity is contradictory.<sup>[15][18]<\/sup><\/span><\/p>\n\n\n\n<p><span style=\"font-weight: 400;\">The most common adverse events observed with vancomycin use are mild and include nausea, vomiting, abdominal pain, diarrhea, flatulence, headache, back pain, fever, and fatigue.<\/span><span style=\"font-weight: 400;\"><sup>[1]<\/sup><\/span><span style=\"font-weight: 400;\"> Regular monitoring is recommended to mitigate these risks.<\/span><\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Vancomycin Pediatric Dose Monitoring<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span style=\"font-weight: 400;\">Laboratory Monitoring<\/span><\/h3>\n\n\n\n<p><span style=\"font-weight: 400;\">Serum concentration is normally collected at steady state trough which usually occurs prior to the administration of the fourth dose.<\/span><span style=\"font-weight: 400;\"><sup>[12]<\/sup><\/span><span style=\"font-weight: 400;\"> Peak concentration has not been shown to correlate to either toxicity or efficacy and is therefore not monitored.<sup>[19]<\/sup> Serum creatinine should be assessed regularly as a measure of renal function.<sup>[14]<\/sup><\/span><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span style=\"font-weight: 400;\">Clinical Monitoring<\/span><\/h3>\n\n\n\n<p><span style=\"font-weight: 400;\">Clinically, symptoms of infection should be assessed regularly. These include body temperature and heart rate. Blood cell counts can also be helpful markers of infection improvement or worsening.<\/span><\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Pharmacokinetics<\/h2>\n\n\n\n<p><span style=\"font-weight: 400;\">To fully understand the dosing paradigm for vancomycin a brief discussion of its pharmacokinetics and pharmacodynamics is necessary. The pharmacokinetics of vancomycin can be described using either a 1-, 2- or 3-compartment model.<sup>[20][25]<\/sup><\/span><\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" width=\"1024\" height=\"932\" src=\"https:\/\/doseme-rx.com\/wp-content\/uploads\/2018\/12\/Vancomycin-compartments-1024x932.jpg\" alt=\"Vancomycin two compartment model\" class=\"wp-image-3459\" srcset=\"https:\/\/doseme-rx.com\/wp-content\/uploads\/2018\/12\/Vancomycin-compartments-1024x932.jpg 1024w, https:\/\/doseme-rx.com\/wp-content\/uploads\/2018\/12\/Vancomycin-compartments-300x273.jpg 300w, https:\/\/doseme-rx.com\/wp-content\/uploads\/2018\/12\/Vancomycin-compartments-768x699.jpg 768w, https:\/\/doseme-rx.com\/wp-content\/uploads\/2018\/12\/Vancomycin-compartments.jpg 1407w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<p><b>Figure 2. A Two-Compartment Model Applied to Vancomycin Pharmacokinetics<\/b><\/p>\n\n\n\n<p>Key: \u03b1, \u00df \u2013 respective elimination constants, A, B \u2013 respective zero time intercepts for \u03b1 and \u00df, C \u2013 concentration, e \u2013 base of the natural logarithm, K0&nbsp;\u2013 infusion rate constant, K12, K21&nbsp;\u2013 intracompartmental rate constants, KEL&nbsp;\u2013 elimination rate constant from the central compartment, t \u2013 time, Vc&nbsp;\u2013 volume of the central compartment, Vp&nbsp;\u2013 volume of the peripheral compartment<\/p>\n\n\n\n<p><em><span style=\"font-weight: 400;\">Source:<\/span><a href=\"https:\/\/academic.oup.com\/cid\/article\/42\/Supplement_1\/S35\/275535\"> <span style=\"font-weight: 400;\">https:\/\/academic.oup.com\/cid\/article\/42\/Supplement_1\/S35\/275535<\/span><\/a><\/em><\/p>\n\n\n\n<p><strong><i>Absorption<\/i><\/strong><span style=\"font-weight: 400;\"><strong>:<\/strong> The bioavailability following intravenous administration is 100%; that of orally administered vancomycin is less than 10%.<sup>[21][22]<\/sup><\/span><\/p>\n\n\n\n<p><strong><i>Distribution<\/i><\/strong><span style=\"font-weight: 400;\"><strong>:<\/strong> With intravenous infusion, distribution typically occurs over a period of about 30 minutes.<\/span><sup>[20]<\/sup><span style=\"font-weight: 400;\">&nbsp;In children the volume of distribution is 0.26 to 1.05 L\/kg.<sup>[23][24]<\/sup><span style=\"font-weight: 400;\"> It is important to note this is more variable than that in adults (0.5 to 0.9 L\/kg).<\/span><\/span><\/p>\n\n\n\n<p><strong><i>Metabolism<\/i><\/strong><span style=\"font-weight: 400;\"><strong>:<\/strong> This is very limited.<\/span><span style=\"font-weight: 400;\"><sup>[20]<\/sup><\/span><\/p>\n\n\n\n<p><strong><i>Excretion<\/i><\/strong><span style=\"font-weight: 400;\"><strong>:<\/strong> Vancomycin is eliminated renally with 80-90% excreted unchanged in the urine.<sup>[20]<\/sup><\/span><span style=\"font-weight: 400;\"> Clearance is slightly higher in children (1.2 mL\/kg\/min) than in adults (1 mL\/kg\/min).<sup>[23][24]<\/sup><\/span><\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Pharmacodynamics<\/h2>\n\n\n\n<p><span style=\"font-weight: 400;\">There are relatively few human pharmacodynamic studies to guide clinicians on how to best monitor efficacy and predict patient outcomes. However, because the bacteriostatic activity of vancomycin is both concentration and time dependent, targeting an AUC24:MIC ratio is now becoming accepted as the most appropriate target. For hospitals without pharmacokinetic modelling software, it is often clinical practice to monitor serum trough levels as a proxy for AUC.<sup>[12]<\/sup> Recent evidence in adults, however, suggests that this may be a suboptimal approach, leading to higher than necessary AUCs and increased risk of nephrotoxicity.<sup>[26]<\/sup><\/span><\/p>\n\n\n\n<h3 class=\"wp-block-heading\">References<\/h3>\n\n\n\n<ol class=\"wp-block-list\"><li><a href=\"http:\/\/www.pdr.net\/drug-summary\/Vancocin-vancomycin-hydrochloride-802\"><span style=\"font-weight: 400;\">http:\/\/www.pdr.net\/drug-summary\/Vancocin-vancomycin-hydrochloride-802<\/span><\/a><\/li><li><a href=\"https:\/\/www.aafp.org\/afp\/2011\/0815\/p455.html\"><span style=\"font-weight: 400;\">https:\/\/www.aafp.org\/afp\/2011\/0815\/p455.html<\/span><\/a><\/li><li><a href=\"http:\/\/www.clinicalpharmacology-ip.com\/Forms\/login.aspx?ReturnUrl=%2fForms%2fMonograph%2fmonograph.aspx%3fcpnum%3d638%26sec%3dmonmech&amp;cpnum=638&amp;sec=monmech\"><span style=\"font-weight: 400;\">http:\/\/www.clinicalpharmacology-ip.com\/Forms\/login.aspx?ReturnUrl=%2fForms%2fMonograph%2fmonograph.aspx%3fcpnum%3d638%26sec%3dmonmech&amp;cpnum=638&amp;sec=monmech<\/span><\/a><\/li><li><a href=\"http:\/\/med.stanford.edu\/content\/dam\/sm\/bugsanddrugs\/documents\/dosing\/2013VancEDloadingdose_000.pdf\"><span style=\"font-weight: 400;\">http:\/\/med.stanford.edu\/content\/dam\/sm\/bugsanddrugs\/documents\/dosing\/2013VancEDloadingdose_000.pdf<\/span><\/a><\/li><li><span style=\"font-weight: 400;\"> Pediatric Dosage Handbook, 15th Edition, 2008<\/span><\/li><li><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3101254\/\"><span style=\"font-weight: 400;\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3101254\/<\/span><\/a><\/li><li><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19106348\"><span style=\"font-weight: 400;\">https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19106348<\/span><\/a><\/li><li><a href=\"https:\/\/www.merriam-webster.com\/medical\/loading%20dose\"><span style=\"font-weight: 400;\">https:\/\/www.merriam-webster.com\/medical\/loading%20dose<\/span><\/a><\/li><li><a href=\"http:\/\/aac.asm.org\/content\/60\/5\/2601.full\"><span style=\"font-weight: 400;\">http:\/\/aac.asm.org\/content\/60\/5\/2601.full<\/span><\/a><\/li><li><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4275137\/\"><span style=\"font-weight: 400;\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4275137\/<\/span><\/a><\/li><li><a href=\"https:\/\/academic.oup.com\/cid\/article\/42\/Supplement_1\/S35\/275535\"><span style=\"font-weight: 400;\">https:\/\/academic.oup.com\/cid\/article\/42\/Supplement_1\/S35\/275535<\/span><\/a><\/li><li><a href=\"http:\/\/www.ajhp.org\/content\/66\/1\/82\"><span style=\"font-weight: 400;\">http:\/\/www.ajhp.org\/content\/66\/1\/82<\/span><\/a><\/li><li><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC270616\/\"><span style=\"font-weight: 400;\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC270616\/<\/span><\/a><\/li><li><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20888013\"><span style=\"font-weight: 400;\">https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20888013<\/span><\/a><\/li><li><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25135822\"><span style=\"font-weight: 400;\">https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25135822<\/span><\/a><\/li><li><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23526674\"><span style=\"font-weight: 400;\">https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23526674<\/span><\/a><\/li><li><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23471688\"><span style=\"font-weight: 400;\">https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23471688<\/span><\/a><\/li><li><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24934335\"><span style=\"font-weight: 400;\">https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24934335<\/span><\/a><\/li><li><a href=\"https:\/\/www.karger.com\/Article\/Abstract\/343162\"><span style=\"font-weight: 400;\">https:\/\/www.karger.com\/Article\/Abstract\/343162<\/span><\/a><\/li><li><a href=\"https:\/\/academic.oup.com\/cid\/article\/42\/Supplement_1\/S35\/275535\"><span style=\"font-weight: 400;\">https:\/\/academic.oup.com\/cid\/article\/42\/Supplement_1\/S35\/275535<\/span><\/a><\/li><li><span style=\"font-weight: 400;\">Griffin, J. P. The Textbook of Pharmaceutical Medicine (6th ed.). New Jersey: BMJ Books<\/span><\/li><li><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK459263\/\"><span style=\"font-weight: 400;\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK459263\/<\/span><\/a><\/li><li><span style=\"font-weight: 400;\"> Micromedex. \u201cVancomycin.\u201d 2015<\/span><\/li><li><span style=\"font-weight: 400;\"> Lexicomp Pediatric Drug Information. \u201cVancomycin.\u201d 2015<\/span><\/li><li><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/m\/pubmed\/9751448\/\"><span style=\"font-weight: 400;\">https:\/\/www.ncbi.nlm.nih.gov\/m\/pubmed\/9751448\/<\/span><\/a><\/li><li><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28923869\/\"><span style=\"font-weight: 400;\">https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28923869\/<\/span><\/a><\/li><\/ol>\n\n\n\n<h3 class=\"wp-block-heading\">Related Posts<\/h3>\n\n\n\n<p>Here are some more vancomycin resources for you:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><a href=\"https:\/\/doseme-rx.com\/vancomycin-dosing-calculator\">Vancomycin Dosing Calculator<\/a><\/li><li><a href=\"https:\/\/doseme-rx.com\/news\/20191119-vancomycin-trough-level-recommendations\">Vancomycin Trough Guidelines and Goals<\/a><\/li><\/ul>\n\n\n\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Note: The new&nbsp;vancomycin dosing guidelines&nbsp;have been officially released. Learn what&#8217;s changed and how they&#8217;ll impact you by reading our guide to the&nbsp;new vancomycin dosing changes&nbsp;here. Vancomycin is a commonly prescribed antibiotic used to treat children and adults with serious infections. Here we review some of the most common indications for vancomycin use and important safety [&hellip;]<\/p>\n","protected":false},"author":4,"featured_media":8219,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[26],"tags":[28,27,37],"article-type":[49],"class_list":["post-3448","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-vancomycin","tag-auc","tag-trough","tag-vancomycin-dosing"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Vancomycin IV Dosing in Pediatrics &#8226; DoseMeRx<\/title>\n<meta name=\"description\" content=\"Here we review some of the most common indications for vancomycin use and safety considerations for using this drug in pediatric patients.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/doseme-rx.com\/de\/vancomycin\/articles\/dosing-pediatrics\" \/>\n<meta property=\"og:locale\" content=\"de_DE\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Vancomycin IV Dosing in Pediatrics &#8226; DoseMeRx\" \/>\n<meta property=\"og:description\" content=\"Here we review some of the most common indications for vancomycin use and safety considerations for using this drug in pediatric patients.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/doseme-rx.com\/de\/vancomycin\/articles\/dosing-pediatrics\" \/>\n<meta property=\"og:site_name\" content=\"DoseMeRx\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/DoseMeApp\/\" \/>\n<meta property=\"article:published_time\" content=\"2018-12-19T05:50:15+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2021-04-13T07:09:33+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/doseme-rx.com\/wp-content\/uploads\/2018\/12\/baby.png\" \/>\n\t<meta property=\"og:image:width\" content=\"1120\" \/>\n\t<meta property=\"og:image:height\" content=\"630\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"author\" content=\"Nicola Hunter\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@DoseMeApp\" \/>\n<meta name=\"twitter:site\" content=\"@DoseMeApp\" \/>\n<meta name=\"twitter:label1\" content=\"Verfasst von\" \/>\n\t<meta name=\"twitter:data1\" content=\"Nicola Hunter\" \/>\n\t<meta name=\"twitter:label2\" content=\"Gesch\u00e4tzte Lesezeit\" \/>\n\t<meta name=\"twitter:data2\" content=\"8\u00a0Minuten\" \/>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Vancomycin IV Dosing in Pediatrics &#8226; DoseMeRx","description":"Here we review some of the most common indications for vancomycin use and safety considerations for using this drug in pediatric patients.","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/doseme-rx.com\/de\/vancomycin\/articles\/dosing-pediatrics","og_locale":"de_DE","og_type":"article","og_title":"Vancomycin IV Dosing in Pediatrics &#8226; DoseMeRx","og_description":"Here we review some of the most common indications for vancomycin use and safety considerations for using this drug in pediatric patients.","og_url":"https:\/\/doseme-rx.com\/de\/vancomycin\/articles\/dosing-pediatrics","og_site_name":"DoseMeRx","article_publisher":"https:\/\/www.facebook.com\/DoseMeApp\/","article_published_time":"2018-12-19T05:50:15+00:00","article_modified_time":"2021-04-13T07:09:33+00:00","og_image":[{"width":1120,"height":630,"url":"https:\/\/doseme-rx.com\/wp-content\/uploads\/2018\/12\/baby.png","type":"image\/png"}],"author":"Nicola Hunter","twitter_card":"summary_large_image","twitter_creator":"@DoseMeApp","twitter_site":"@DoseMeApp","twitter_misc":{"Verfasst von":"Nicola Hunter","Gesch\u00e4tzte Lesezeit":"8\u00a0Minuten"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/doseme-rx.com\/de\/vancomycin\/articles\/dosing-pediatrics#article","isPartOf":{"@id":"https:\/\/doseme-rx.com\/de\/vancomycin\/articles\/dosing-pediatrics"},"author":{"name":"Nicola Hunter","@id":"https:\/\/doseme-rx.com\/de#\/schema\/person\/6c6769e1f0b02564d00c6693857210d9"},"headline":"Vancomycin Dosing in Pediatrics","datePublished":"2018-12-19T05:50:15+00:00","dateModified":"2021-04-13T07:09:33+00:00","mainEntityOfPage":{"@id":"https:\/\/doseme-rx.com\/de\/vancomycin\/articles\/dosing-pediatrics"},"wordCount":1736,"commentCount":0,"image":{"@id":"https:\/\/doseme-rx.com\/de\/vancomycin\/articles\/dosing-pediatrics#primaryimage"},"thumbnailUrl":"https:\/\/doseme-rx.com\/wp-content\/uploads\/2018\/12\/baby.png","keywords":["AUC","Trough","Vancomycin Dosing"],"articleSection":["Vancomycin"],"inLanguage":"de","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/doseme-rx.com\/de\/vancomycin\/articles\/dosing-pediatrics#respond"]}]},{"@type":"WebPage","@id":"https:\/\/doseme-rx.com\/de\/vancomycin\/articles\/dosing-pediatrics","url":"https:\/\/doseme-rx.com\/de\/vancomycin\/articles\/dosing-pediatrics","name":"Vancomycin IV Dosing in Pediatrics &#8226; DoseMeRx","isPartOf":{"@id":"https:\/\/doseme-rx.com\/de#website"},"primaryImageOfPage":{"@id":"https:\/\/doseme-rx.com\/de\/vancomycin\/articles\/dosing-pediatrics#primaryimage"},"image":{"@id":"https:\/\/doseme-rx.com\/de\/vancomycin\/articles\/dosing-pediatrics#primaryimage"},"thumbnailUrl":"https:\/\/doseme-rx.com\/wp-content\/uploads\/2018\/12\/baby.png","datePublished":"2018-12-19T05:50:15+00:00","dateModified":"2021-04-13T07:09:33+00:00","author":{"@id":"https:\/\/doseme-rx.com\/de#\/schema\/person\/6c6769e1f0b02564d00c6693857210d9"},"description":"Here we review some of the most common indications for vancomycin use and safety considerations for using this drug in pediatric patients.","breadcrumb":{"@id":"https:\/\/doseme-rx.com\/de\/vancomycin\/articles\/dosing-pediatrics#breadcrumb"},"inLanguage":"de","potentialAction":[{"@type":"ReadAction","target":["https:\/\/doseme-rx.com\/de\/vancomycin\/articles\/dosing-pediatrics"]}]},{"@type":"ImageObject","inLanguage":"de","@id":"https:\/\/doseme-rx.com\/de\/vancomycin\/articles\/dosing-pediatrics#primaryimage","url":"https:\/\/doseme-rx.com\/wp-content\/uploads\/2018\/12\/baby.png","contentUrl":"https:\/\/doseme-rx.com\/wp-content\/uploads\/2018\/12\/baby.png","width":1120,"height":630},{"@type":"BreadcrumbList","@id":"https:\/\/doseme-rx.com\/de\/vancomycin\/articles\/dosing-pediatrics#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/doseme-rx.com\/de"},{"@type":"ListItem","position":2,"name":"Vancomycin Dosing in Pediatrics"}]},{"@type":"WebSite","@id":"https:\/\/doseme-rx.com\/de#website","url":"https:\/\/doseme-rx.com\/de","name":"DoseMeRx","description":"Choose us for our world-leading Bayesian dosing software. Stay with us for our best-in-class customer service.","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/doseme-rx.com\/de?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"de"},{"@type":"Person","@id":"https:\/\/doseme-rx.com\/de#\/schema\/person\/6c6769e1f0b02564d00c6693857210d9","name":"Nicola Hunter","image":{"@type":"ImageObject","inLanguage":"de","@id":"https:\/\/secure.gravatar.com\/avatar\/02e206174499150c025ce2682b2ee353f284349ff867886a3f957d50c95af6fe?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/02e206174499150c025ce2682b2ee353f284349ff867886a3f957d50c95af6fe?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/02e206174499150c025ce2682b2ee353f284349ff867886a3f957d50c95af6fe?s=96&d=mm&r=g","caption":"Nicola Hunter"},"url":"https:\/\/doseme-rx.com\/de\/author\/nicola-hunter"}]}},"_links":{"self":[{"href":"https:\/\/doseme-rx.com\/de\/wp-json\/wp\/v2\/posts\/3448","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/doseme-rx.com\/de\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/doseme-rx.com\/de\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/doseme-rx.com\/de\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/doseme-rx.com\/de\/wp-json\/wp\/v2\/comments?post=3448"}],"version-history":[{"count":30,"href":"https:\/\/doseme-rx.com\/de\/wp-json\/wp\/v2\/posts\/3448\/revisions"}],"predecessor-version":[{"id":5355,"href":"https:\/\/doseme-rx.com\/de\/wp-json\/wp\/v2\/posts\/3448\/revisions\/5355"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/doseme-rx.com\/de\/wp-json\/wp\/v2\/media\/8219"}],"wp:attachment":[{"href":"https:\/\/doseme-rx.com\/de\/wp-json\/wp\/v2\/media?parent=3448"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/doseme-rx.com\/de\/wp-json\/wp\/v2\/categories?post=3448"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/doseme-rx.com\/de\/wp-json\/wp\/v2\/tags?post=3448"},{"taxonomy":"article-type","embeddable":true,"href":"https:\/\/doseme-rx.com\/de\/wp-json\/wp\/v2\/article-type?post=3448"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}