Residents and Fellows Research in Progress
Sunday, November 12, 2023
12:45 PM–02:15 PM
Abstract
Introduction:
The optimal dose for intermittent intravenous vancomycin infusion in children is unknown despite the availability of international consensus guidelines. Intermittent vancomycin dosing recommended by national guidelines has been reported as inadequate in paediatric population, leading to subtherapeutic plasma levels and potential treatment failures. This clinical audit aims to evaluate the adherence of current prescribing and therapeutic drug monitoring to local guidance.
Research Question or Hypothesis:
At least 80% compliance with audit standards is expected to be achieved.
Study Design:
A prospective clinical audit was conducted over a 4-month period in all paediatric wards. Patients aged between 1 month to 16 years treated with intermittent vancomycin infusion, were included and followed throughout the audit period.
Methods:
Data were collected from the electronic patient record. The relevant data were coded and transferred to SPSS for data analysis. Descriptive analysis was performed.
Results:
A total of 26 patients were involved in the audit, comprising 33 intermittent vancomycin courses with 290 plasma vancomycin concentrations. The audit findings did not meet the expected targets, as compliance rates ranged from 21% to 78%. 27.3% (45/165) of vancomycin concentrations fell within the therapeutic range after being dosed and sampled correctly. 30.3% (10/33) courses were consistently subtherapeutic throughout treatment, with a median of 3 (IQR 2-6) days to reach therapeutic levels. A median dose of 72 (IQR 60-88)mg/kg/day was required to achieve a median trough level of 12.7 (IQR 7.6-17.5)mg/L in children 1 month to 16 years.
Conclusion:
Current dosing guidance proved insufficient in achieving timely therapeutic plasma concentrations in most patients. A new guideline will be implemented and standardised based on a new South East London joint formulary guideline. Re-audit of the revised guideline is necessary in the future to assess its effectiveness. Further research studies are needed to identify the optimal vancomycin dose for children.
Presenting Author
Yi Jun Chong -University College London, United Kingdom
Authors
Maja Begovic -
University College London
Sammie Jones -
King’s College Hospital NHS Foundation Trust
Joanne Crook -
King’s College Hospital NHS Foundation Trust