Table 2

Characteristics of the studies, PK and dose recommendations related to vancomycin

StudynPNAWeightTypeGroupModelModalityAdministered doseVdCLt1/2 (hours)Recommended dose
Mulla and Pooboni,21 UK*158.23.5P and RChildren2-compartment with WinNonMixVV–VA10–15 mg/kg every 6–24 hours0.45±0.1 L/kg
0.04±0.02 L/kg/hour
Cies et al,18 USA†‡129.53.1RNeonates1-compartment with PmetricsVV–VA10–15 mg/kg every 8–24 hours1.2±0.4 L/kg
0.21±0.08 L/kg/hour
Zylbersztajn et al,19 Chile§‡24
(2–132) months
10 (3.5–37)PChildren2-compartment with PmetricsVV–VA10–15 mg/kg every 6–12 hours0.42±0.28 L/kg
0.06±0.05 L/kg/hour
Across each dosing interval, 63.6% of patients achieved the PK/PD targets for adequate exposure.
Moffett et al,20 USA§‡N: 28
0.64 (0.07–6.7) years7.6 (3.7–21.9)RChildren2-compartment with NONMEMVV–VA25 mg/kg every 18 hours for neonates
30 mg/kg every 12 hours for infants
Vdcentral: 0.36 L/kg
Vdperipheral: 0.46 L/kg
0.06 L/kg/hour
25–30 mg/kg/dose every 12–24 hours with serum concentration monitoring is a reasonable empirical dosing strategy to obtain an area under the curve for 24 hours greater than 400.
  • Boldfaced fonts represent comparisons with controls within the same study. In other studies, they represent comparisons with non-ECMO neonates from a different published study.

  • *The reference range for serum vancomycin concentrations was trough 5–15 mg/L.

  • †The reference range for serum vancomycin concentrations was trough >10 mg/L.

  • ‡De Hoog et al's neonatal PK data were used to compare Vd (0.57–0.69 L/kg) and Cl (0.04–0.09 L/kg/hour).48

  • §The reference range for serum vancomycin concentrations was trough <15 mg/L.

  • CL, clearance; ECMO, extracorporeal membrane oxygenation; I, infants; N, neonates; NONMEM, non-linear mixed-effects modelling; P, prospective; PD, pharmacodynamics; PK, pharmacokinetics; PNA, postnatal age; R, retrospective; t1/2, elimination half-life; VA, veno-arterial; Vd, volume of distribution; VV, veno-venous.