AI Article Synopsis
- Vancomycin is a long-used antibiotic for treating gram-positive infections in hospitals, but its benefits as a loading dose for neonates remain debated.
- The study examined how vancomycin loading doses affect achieving therapeutic targets in neonates with sepsis by comparing data before and after guideline changes in a South African neonatal unit.
- Results showed that neonates receiving loading doses had significantly earlier target attainment, but overall target achievement at 24 hours was similar between both groups, with low rates of kidney toxicity observed.
Article Abstract
Background: Vancomycin is a glycopeptide antibiotic that has been used to treat hospital-acquired gram-positive infections for more than 5 decades. However, the literature is divided regarding the therapeutic advantages of vancomycin loading doses in neonates.
Objectives: This study aimed to investigate the effect of vancomycin loading doses on therapeutic target attainment in neonates with sepsis.
Methods: A retrospective cohort study was conducted to compare the vancomycin target attainment (area under the curve 0-24 hours/minimum inhibitory concentration ≥400) in neonates before and after the 2019 change in vancomycin prescription guidelines at a neonatal unit in Cape Town, South Africa. As the standard of care, Bayesian modelling software was used to compute the area under the curve from the trough concentrations.
Results: Two hundred ten neonates were included. Multivariate regression analysis showed a 2-fold increase in the odds of target attainment among neonates receiving a loading dose of vancomycin. Early target attainment (within 8-12 hours of treatment initiation) was significantly higher in the loading dose group compared with the no loading dose group [97/105 (92.4%) versus 64/105 (61.0%); P < 0.001]. However, the overall proportion of neonates achieving target attainment at 24 hours was similar between groups [73/105 (69.5%) in the loading dose group versus 62/105 (59.0%) in the no loading dose group; P = 0.110]. The nephrotoxicity rates were low [2/105 (1.9%) in the loading dose group and 2/105 (1.9%) in the no loading dose group].
Conclusions: The addition of a vancomycin loading dose to neonates may facilitate early therapeutic target attainment.
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| http://dx.doi.org/10.1097/FTD.0000000000001234 | DOI Listing |
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