Optimization of vancomycin dosing to achieve target area under the curve in pediatrics

Tyler E. Bosley, Robert J. Kuhn, Brian Gardner, Elizabeth B. Autry, Madeline Fuller, Colleen L. Overley

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


OBJECTIVE Vancomycin dosing requirements to achieve a target area under curve/minimum inhibitory concentration (AUC/MIC) of 400 to 600 mg•hr/L have not been established in pediatrics. Dose modeling studies and recent guidelines suggest dosing higher than historical recommendations. This study examines dosing requirements to achieve target AUC/MIC in human pediatric patients. METHODS This retrospective study includes 77 patients, aged 1 month to 18 years, at a single center, who received at least 2 days of intravenous vancomycin with a pharmacokinetic monitoring note and calculated AUC/MIC. Dosing to achieve target AUC/MIC was evaluated by age and indication. Nephrotoxicity was also assessed. RESULTS The mean dose required to achieve target AUC/MIC for all patients was 67.7 mg/kg/day. Adjusting for age, the mean dose required to achieve target AUC/MIC of 400 to 600 mg•hr/L was found to be statistically significantly different among 3 age cohorts: 1 month to 5 years, 6 to 12 years, and 13 to 18 years [F(2,74) = 15.32, p < 0.001], with mean requirements of 79 ± 14.1, 65.6 ± 21.1, and 53.9 ± 17.1 mg/kg/day, respectively. Dosing requirements were also found to be statistically significantly different across indications [F(6,70) = 4.84, p < 0.001]. Acute kidney injury was identified in 5 patients (6.5%). CONCLUSIONS The vancomycin dose required to achieve target AUC/MIC in pediatrics was significantly higher in younger pediatric patients and ranged from 53.9 to 79 mg/kg/day, confirming recent guideline recommendations. Doses can be further adjusted for indication. Nephrotoxicity rates remain low compared with historical rates with single trough monitoring. ABBREVIATIONS AKI, acute kidney injury; ANOVA, analysis of variance; AUC, area under the curve; eGFR, estimated glomerular filtration rate; EHR, electronic health record; HEENT, head eyes ears nose throat; IDSA, Infectious Diseases Society of America; IV, intravenous; KDIGO, Kidney Disease: Improving Global Outcomes; MIC, minimum inhibitory concentration; MRSA, methicillin-resistant Staphylococcus aureus.

Original languageEnglish
Pages (from-to)746-752
Number of pages7
JournalJournal of Pediatric Pharmacology and Therapeutics
Issue number7
StatePublished - 2021

Bibliographical note

Publisher Copyright:
© 2021, Pediatric Pharmacy Advocacy Group, Inc.. All rights reserved.


  • AUC
  • Dosing
  • Pediatric
  • Pharmacokinetics
  • Target attainment
  • Vancomycin

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pharmacology (medical)


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