Factors impacting unbound vancomycin concentrations in neonates and young infants

European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology
A SmitsK Allegaert

Abstract

Vancomycin pharmacokinetic (PK) and pharmacodynamic (PD) data in neonates are based on total concentrations. However, only unbound vancomycin is pharmacologically active. The objective was to determine vancomycin protein binding and the covariates impacting unbound vancomycin concentration in neonates and young infants. In neonates and young infants to whom vancomycin was administered intermittently for medical indications, total and unbound vancomycin plasma concentrations were determined using LC-MS/MS. Sampling occurred randomly during vancomycin exposure, covering a broad range of concentrations. Impact of covariates on unbound vancomycin concentration was determined using linear regression. Significant results of the univariate regressions were entered in a stepwise multiple regression. Passing-Bablok regression and Bland-Altman were used to assess the difference between measured and calculated unbound vancomycin concentration. Thirty-seven samples in 33 patients (median (interquartile range) gestational age 35 (29-39) weeks) were collected. Median total and unbound vancomycin concentrations were 14.2 (7.4-20.6) and 13.6 (7.2-22.5) mg/L, respectively. Median unbound fraction was 0.90 (0.77-0.98). Multiple regression reveal...Continue Reading

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Citations

Sep 25, 2018·Journal of Clinical Pharmacology·John van den AnkerGregory L Kearns
Dec 18, 2018·Expert Opinion on Drug Metabolism & Toxicology·Anne SmitsKarel Allegaert
Mar 6, 2019·British Journal of Clinical Pharmacology·Stéphanie LerouxKarel Allegaert
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Feb 11, 2021·Journal of Infection and Chemotherapy : Official Journal of the Japan Society of Chemotherapy·Hiromu MoriyamaKazuaki Matsumoto
Dec 16, 2020·Antimicrobial Agents and Chemotherapy·Hiroshi SasanoKazuhiko Hanada
Feb 17, 2021·The Pediatric Infectious Disease Journal·Helgi PadariIrja Lutsar
Jul 28, 2021·Expert Review of Clinical Pharmacology·Quyen TuJason A Roberts
Sep 18, 2021·The Pediatric Infectious Disease Journal·Christopher M RubinoKamal Hamed
Aug 17, 2021·Antimicrobial Agents and Chemotherapy·Christopher M RubinoKamal Hamed

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Methods Mentioned

BETA
PMA

Clinical Trials Mentioned

NCT02096536

Software Mentioned

Medcalc®
Medcalc

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