Document Detail


Clinical pharmacokinetics of vancomycin in the neonate: a review.
MedLine Citation:
PMID:  22892931     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Neonatal sepsis is common and is a major cause of morbidity and mortality. Vancomycin is the preferred treatment of several neonatal staphylococcal infections. The aim of this study was to review published data on vancomycin pharmacokinetics in neonates and to provide a critical analysis of the literature. A bibliographic search was performed using PubMed and Embase, and articles with a publication date of August 2011 or earlier were included in the analysis. Vancomycin pharmacokinetic estimates, which are different in neonates compared with adults, also exhibit extensive inter-neonatal variability. In neonates, several vancomycin dosing schedules have been proposed, mainly based on age (i.e., postmenstrual and postnatal), body weight or serum creatinine level. Other covariates [e.g., extracorporeal membrane oxygenation (ECMO), indomethacin or ibuprofen, and growth restriction] of vancomycin pharmacokinetics have been reported in neonates. Finally, vancomycin penetrates cerebrospinal fluid (range = 7-42%). Renal function drives vancomycin pharmacokinetics. Because either age or weight is the most relevant covariate of renal maturation, these covariates should be considered first in neonatal vancomycin dosing guidelines and further adjusted by renal dysfunction indicators (e.g., ECMO and ibuprofen/indomethacin). In addition to the prospective validation of available dosing guidelines, future studies should focus on the relevance of therapeutic drug monitoring and on the value of continuous vancomycin administration in neonates.
Authors:
Gian Maria Pacifici; Karel Allegaert
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Clinics (São Paulo, Brazil)     Volume:  67     ISSN:  1980-5322     ISO Abbreviation:  Clinics (Sao Paulo)     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-08-15     Completed Date:  2013-06-12     Revised Date:  2013-07-12    
Medline Journal Info:
Nlm Unique ID:  101244734     Medline TA:  Clinics (Sao Paulo)     Country:  Brazil    
Other Details:
Languages:  eng     Pagination:  831-7     Citation Subset:  IM    
Affiliation:
University of Pisa, Medical School, Department of Neurosciences, Section of Pharmacology, Pisa/IT. pacifici@biomed.unipi.it
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Anti-Bacterial Agents / administration & dosage,  pharmacokinetics*
Drug Monitoring
Humans
Infant, Newborn
Infant, Premature, Diseases / drug therapy,  metabolism
Kidney / metabolism
Sepsis / drug therapy,  metabolism*
Vancomycin / administration & dosage,  pharmacokinetics*
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 1404-90-6/Vancomycin
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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