Optimization of vancomycin dosing in very low-birth-weight preterm neonates

Objective To compare vancomycin serum trough concentrations and 24-hour area under the serum concentration-versus-time curve (AUC₂₄) among very low-birth-weight (VLBW) premature infants before and after implementation of an institution-wide increase in neonatal vancomycin dosing.

Study Design We performed a retrospective analysis of vancomycin concentrations among preterm VLBW neonates before (2007-2010) and after (2010-2013) implementation of a new vancomycin dosing protocol consisting of increased vancomycin daily dose and frequency of administration.

Results Neonates weighing < 1,500 g and receiving the new vancomycin dosing regimen had lower rates of undetectable trough concentrations (24 vs. 50%, p = 0.04), higher median trough concentrations (10.8 vs. 5.9 μg/mL, p = 0.003), a higher proportion of goal trough concentrations of 10 to 20 μg/mL (35 vs. 4%, p = 0.005), and a significantly higher vancomycin AUC₂₄ (438 vs. 320 mg·h/L, p = 0.004) compared with historical controls.

Conclusion Increasing the vancomycin daily dose and dosing frequency led to an increase in vancomycin trough concentrations and AUC₂₄, and a decrease in the proportion of undetectable (< 5.0 μg/mL) troughs, without an increase in toxicity among VLBW premature neonates.