Document Detail

Vancomycin elimination in human infants with intrauterine growth retardation.
MedLine Citation:
PMID:  16282933     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Intrauterine growth retardation (IUGR) results in substantial decrease in nephron number and renal and hepatic organ mass in experimental animals and newborn infants. Because the liver and the kidneys are the major organs for drug biotransformation and elimination, any decrease in their size and function may lead to impaired metabolism and elimination of drugs in newborns with IUGR. Our objective was to test the hypothesis that IUGR results in prolonged renal elimination of vancomycin in newborns. METHODS: Small for gestational age (SGA) infants (n = 20) were matched with appropriate for gestational age (AGA) infants (n = 123). Steady state peak and trough serum concentrations were used to calculate vancomycin clearance (Cl), volume of distribution (Vd) and half-life (t(1/2)) for each subject. Pharmacokinetic profiles were compared between groups. RESULTS: Overall, Cl, Vd and t(1/2) of vancomycin were the same between groups. However, stratification showed decreased Cl in those SGA versus AGA newborns 3-4 weeks old and in those newborns with a postconceptional age of 27-29 weeks. There was no difference in Vd, normalized for weight, between SGA and AGA babies. The half-life of vancomycin was similar across most groups but was prolonged in SGA newborns aged 3-4 weeks. CONCLUSIONS: Vancomycin Cl differs between SGA and AGA newborns. This difference is greatest early in life and normalizes between groups after the fourth week of life or after 29 weeks postconceptionally. Normalized Vd is similar between SGA and AGA newborns. The elimination of vancomycin is comparable between SGA and AGA infants, except before the fifth week of life, when SGA newborns may eliminate the drug more slowly. Specific vancomycin dose recommendations for SGA versus AGA neonates may therefore be justified during the first month of life.
Daniel A C Frattarelli; Hakan Ergun; Marianne Lulic-Botica; Victoria Tutag Lehr; Jacob V Aranda
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  The Pediatric infectious disease journal     Volume:  24     ISSN:  0891-3668     ISO Abbreviation:  Pediatr. Infect. Dis. J.     Publication Date:  2005 Nov 
Date Detail:
Created Date:  2005-11-11     Completed Date:  2006-01-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8701858     Medline TA:  Pediatr Infect Dis J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  979-83     Citation Subset:  IM    
Division of Clinical Pharmacology, Children's Hospital of Michigan, Detroit, MI, USA.
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MeSH Terms
Area Under Curve
Birth Weight / physiology
Fetal Growth Retardation / metabolism,  physiopathology*
Gestational Age
Infant, Newborn
Infant, Small for Gestational Age*
Infusions, Intravenous
Kidney / growth & development*,  metabolism*
Metabolic Clearance Rate
Organ Size
Vancomycin / pharmacokinetics*
Reg. No./Substance:

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