Vancomycin Therapeutic Targets and Nephrotoxicity in Critically Ill Children With Cancer

Vancomycin Therapeutic Targets and Nephrotoxicity in Critically Ill Children With Cancer

Author Seixas, Glaucia T. F. Autor UNIFESP Google Scholar
Araujo, Orlei R. Autor UNIFESP Google Scholar
Silva, Dafne C. B. Autor UNIFESP Google Scholar
Arduini, Rodrigo G. Autor UNIFESP Google Scholar
Petrilli, Antonio S. Autor UNIFESP Google Scholar
Abstract To obtain pharmacokinetic and pharmacodynamic data for vancomycin in a cohort of critically ill pediatric oncology patients, we analyzed 256 measurements of vancomycin concentrations in 94 patients. Variables were tested as possible risk factors for vancomycin-related nephrotoxicity or death for 28 days. We found the following: mean vancomycin trough serum concentration, 15.6 +/- 12.4 g/mL; mean vancomycin clearance, 0.16 +/- 0.098 L/h/kg; and mean vancomycin distribution volume, 1.04 +/- 0.11 L/kg. Only 13.6% of serum trough level measurements were between 15 and 20 g/mL. The trough levels showed a strong correlation with the AUC (area under the curve of serum concentrations vs. time over 24 h to the minimum inhibitory concentration ratio), with a 94% positive predictive value for AUC/MIC400, but only for MIC=1. The doses that are currently used (60 mg/kg/d) attained the therapeutic target (AUC/MIC400) in only 56% of measurements, considering MIC=1. A serum trough level of 20 g/mL was an independent risk for nephrotoxicity (P=0.0008; odds ratio=17.83). Vancomycin-related nephrotoxicity was a predictor of death for up to 28 days (P=0.003, odds ratio=7.68). Currently administered doses of vancomycin do not reach the therapeutic target for critical cancer patients, particularly if staphylococci isolates have a MIC>1.
Keywords vancomycin
oncology
pediatrics
drug-related side effects and adverse reactions
xmlui.dri2xhtml.METS-1.0.item-coverage Philadelphia
Language English
Date 2016
Published in Journal Of Pediatric Hematology Oncology. Philadelphia, v. 38, n. 2, p. E56-E62, 2016.
ISSN 1077-4114 (Sherpa/Romeo, impact factor)
Publisher Lippincott Williams & Wilkins
Extent E56-E62
Origin http://dx.doi.org/10.1097/MPH.0000000000000470
Access rights Closed access
Type Article
Web of Science ID WOS:000372852700002
URI https://repositorio.unifesp.br/handle/11600/57865

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