ESPN 51th Annual Meeting

ESPN 2018

Aditi Sinha 1 Pamela Slack 2 Dean Wallace 2 Amrit Kaur 2

1- All India Institute of Medical Sciences, New Delhi, India
2- Royal Manchester Children Hospital, Manchester, UK

Antimicrobial dosing guidelines recommend targeting vancomycin trough concentrations of 10-20 mg/L to avoid treatment failure, but lack advice on dosing frequency in patients on intermittent hemodialysis (IHD). The effect of residual renal function on urinary vancomycin clearance is unclear.

Material and methods:

We retrospectively reviewed records of all paediatric IHD patients who received ≥1 doses of vancomycin and underwent ≥1 pre-IHD vancomycin levels. Patients who required other forms of renal replacement were excluded. Vancomycin was administered at 10 mg/kg body weight after IHD if catheter-related bloodstream infection was suspected, and repeated, in patients with suspected septicaemia or confirmed bacteremia, if and when trough level, assessed pre-IHD, was <10-15 mg/L, based on clinician’s discretion, for 7-21 days. Anephric patients were compared to those with urine output using appropriate tests. 


During 2015-2017, 35 episodes of vancomycin administration occurred in 12 patients (7 boys) with median age 6 (interquartile range, IQR 3-10) years, including 13 episodes in 5 anephric patients. Redose was due after 2.6±1.6 days for trough level of 8.0±3.8 mg/L; level was <10 mg/L in 73% cases. Anephric patients and those making urine did not differ significantly in the time to redosing (2.5±1.1 vs. 2.6±1.6 days), trough levels (8.7±3.5 vs. 7.6±4.0 mg/L) and proportions with level <10 mg/L (62% vs. 80%) (all P >0.05). Of 16 episodes requiring therapy ≥7 days, median 7 (IQR 3-10) levels were performed and 4 (3-7) doses of vancomycin given; the average level and dosing interval during therapy were 13.4 (7.8-14.9) mg/L and 3.3 (2.8-3.8) days. Anephric patients and those making urine did not differ significantly in the number of doses required or trough levels achieved


 Paediatric IHD patients given vancomycin at 10 mg/kg may be tested and redosed at ≥48 hour intervals, regardless of urine ou tput, to achieve goal pre-IHD vancomycin level of 10–20 mg/L.