ArticleJournal of the Pediatric Infectious Diseases Society2015
Pharmacodynamic Characteristics of Nephrotoxicity Associated With Vancomycin Use in Children.
Article in Journal of the Pediatric Infectious Diseases Society, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 47 papers, 3 of them syntheses that pooled it.
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Who cites it
47 citing papers in PubMed, 3 syntheses or guidelines pooled it, 98 citations in OpenAlex.
- Relationship between Vancomycin Trough Serum Concentrations and Clinical Outcomes in Children: a Systematic Review and Meta-Analysis.Antimicrobial agents and chemotherapy · 2022Pooled it
- Pharmacokinetics of Vancomycin in Critically Ill Children: A Systematic Review.European journal of drug metabolism and pharmacokinetics · 2022Pooled it
- Determining the optimal vancomycin daily dose for pediatrics: a meta-analysis.European journal of clinical pharmacology · 2017Pooled it
- Vancomycin AUCAntibiotics (Basel, Switzerland) · 2026Article
- Population Pharmacokinetic and Exposure-Response Analysis of Vancomycin Nephrotoxicity in Cystic Fibrosis Patients.Pediatric pulmonology · 2026Article
- Machine-learning prediction of pre-dose pharmacokinetics optimizes initial vancomycin dosing in critically ill children.Frontiers in pharmacology · 2026Article
- Feasibility of vancomycin AUCFrontiers in pharmacology · 2026Article
- Methicillin-resistantThe Lancet regional health. Western Pacific · 2025Review
- Multiple Model Optimal Sampling Promotes Accurate Vancomycin Area-Under-the-Curve Estimation Using a Single Sample in Critically Ill Children.Therapeutic drug monitoring · 2025Article
- Vancomycin in Pediatric Patients with Cystic Fibrosis: Dose Optimization Using Population Pharmacokinetic Approach.European journal of drug metabolism and pharmacokinetics · 2024Article
- Article
- CDC Guidelines for the Prevention and Treatment of Anthrax, 2023.MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports · 2023Article
- Optimizing Vancomycin Therapy in Critically Ill Children: A Population Pharmacokinetics Study to Inform Vancomycin Area under the Curve Estimation Using Novel Biomarkers.Pharmaceutics · 2023Article
- Population pharmacokinetics of vancomycin in very low birth weight neonates.Frontiers in pediatrics · 2023Article
- Vancomycin efficiency and safety of a dosage of 40-60 mg/kg/d and corresponding trough concentrations in children with Gram-positive bacterial sepsis.Frontiers in cellular and infection microbiology · 2023Article
- Comparison of Vancomycin Trough-Based and 24-Hour Area Under the Curve Over Minimum Inhibitory Concentration (AUC/MIC)-Based Therapeutic Drug Monitoring in Pediatric Patients.The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG · 2023Article
- Sorting Out the Risks and Benefits of the #797 Recommended Intrapartum Vancomycin Dosing Approach.Antibiotics (Basel, Switzerland) · 2022Article
- Role of Daptomycin in Cutaneous Wound Healing: A Narrative Review.Antibiotics (Basel, Switzerland) · 2022Article
- Machine Learning Approach to Predicting Absence of Serious Bacterial Infection at PICU Admission.Hospital pediatrics · 2022Article
- Pharmacokinetics and pharmacodynamics of peptide antibiotics.Advanced drug delivery reviews · 2022Review
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Authors and funding
9 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundLimited studies incorporating population-based pharmacokinetic modeling have been conducted to determine pharmacodynamic indices associated with nephrotoxicity during vancomycin exposure in children.
methodsA retrospective cohort analysis was conducted from September 2003 to December 2011 at 2 hospitals. Nephrotoxicity was defined as an increase in serum creatinine concentration (SCr) by ≥0.5 mg/dL, or ≥50% increase in baseline SCr, either persisting for ≥2 consecutive days. A 1-compartment model with first-order kinetics was used in NONMEM 7.2 to estimate trough concentrations (Cmin) and area under the curve over 24 hours (AUC). Univariate, classification and regression tree (CART), and multivariate analyses were conducted to identify factors contributing to nephrotoxicity.
resultsThe analyses included 680 pediatric subjects with 1576 vancomycin serum concentrations. Based on univariate analysis, median Cmin (14.2 [interquartile range, IQR, 7.1-25.4] vs 8.4 [IQR, 5.5-12.4] mcg/mL; P = .001) and AUC (544 [IQR, 359-801] vs 378 [IQR, 304-494]; P < .001) were significantly higher in the nephrotoxic group compared with the non-nephrotoxic group. Using CART, we discovered that subjects with doses ≥60 mg/kg per day and AUC >1063 mg-h/L had a significantly higher occurrence of nephrotoxicity (P = .005). Adjusting for intensive care unit stay and concomitant nephrotoxic drugs, steady-state vancomycin Cmin ≥15 mcg/mL (adjusted odds ratio [aOR], 2.5; 95% confidence interval [CI], 1.1-5.8; P = .028) and AUC ≥800 mg-h/L (aOR, 3.7; 95% CI, 1.2-11.0; P = .018) were associated with increased risk of nephrotoxicity.
conclusionsOur study describes the pediatric exposure-nephrotoxicity relationships for vancomycin. Vancomycin Cmin ≥15 mcg/mL and AUC ≥800 mg-h/L in children are independently associated with a > 2.5-fold increased risk of nephrotoxicity and may provide justification for use of alternative antibiotics in selected situations.
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