2026 Eastern States Conference

Authors:
Jasmine Ramirez, PharmD1; Kayla Marks, PharmD, BCPPS1; Iman Moawad, PharmD, BCPPS1; Alexandra Sharpe, PharmD, BCPS, BCPPS1; Adele Ye, PharmD1; Chadi El Saleeby, MD2
1Department of Pharmacy, Massachusetts General Hospital, Boston, MA
2Harvard Medical School, Boston, MA

Background: 
Evaluate adherence, safety, and target goal attainment (AUC0-24/MIC ratio between 400 and 600) of current institutional pediatric vancomycin protocol.

Learning Objective:
Evaluate outcomes associated with an institutional AUC/MIC based pediatric vancomycin dosing protocol.

Methods:
A retrospective chart review was conducted on pediatric patients (1 month-17 years) admitted to general pediatrics or pediatric intensive care unit and received vancomycin during 11/1/2024-11/1/2025 with levels measured. Patients with prior vancomycin intolerance, pre-existing renal dysfunction, or without levels measured were excluded. Initial vancomycin dosing was based on institutional pediatric protocol with a target AUC/MIC of 400-600mg*hr/L, assuming MIC <1. Collected patient data included age, sex, height, weight, and level of care. Collected vancomycin parameters included infectious indication, dose, and patient-specific pharmacokinetic data. Concomitant nephrotoxins and instances of nephrotoxicity were collected to assess safety. The primary outcome was the percentage of patients dosed by protocol achieving therapeutic AUC/MIC. The secondary outcome was safety.

Results:
A total of 86 patients were reviewed for eligibility and 76 patients met inclusion criteria. Of the patients included, 60 patients were dosed in compliance with institutional pediatric vancomycin dosing protocol. From these 60 patients, 53.3% of patients achieved an initial therapeutic AUC/MIC and 70% of patients reached therapeutic AUC/MIC prior to vancomycin discontinuation. One of these patients developed an acute kidney injury and one patient had a vancomycin infusion reaction. Children > 37.6 kg received a maximum dose of 750 mg every 6 hours per protocol. In this population subset, 87.5% of patients achieved therapeutic AUC/MIC at initial measurement compared to 40.9% of patients who were dosed according to weight.

Conclusion:
In the majority of patients, institutional dosing protocol was able to attain therapeutic AUC/MIC at first measurement. Areas for protocol improvement include initial dosing recommendations in patients who were dosed according to weight, consideration of a loading dose, and evaluation of using a single level to extract AUC/MIC from population kinetics. While the current protocol is safe, a larger study population is needed to determine specific dosing adjustments.