Vancomycin dosing regimens – validation needed

A prospective observational study of vancomycin trough levels using two different dosing regimens in over 200 neonates found that vancomycin trough levels of less than 10 mg/L were quite common (70% of trough levels were below this level). These suboptimal levels were associated with lower birth weight, lower gestational age and lower post-menstrual age.  Other important points emphasized in this article are:

1. In neonates the optimal trough targets are unknown (the current recommendation of trough level greater than 10 mg/L is based on adult regimens).

2. In adults, trough concentrations are a surrogate for the real measure of interest, which is the ratio of the area under the curve 0-24 / minimal inhibitory concentration (goal is to have this ratio at 400 or higher). However, the optimal parameter for vancomycin efficacy in neonates is unknown.

Prospective validation of neonatal vancomycin dosing regimens is urgently needed. Vandendriessche et al. 2014.