Arch Dis Child 98:447-448 doi:10.1136/archdischild-2012-303414
  • Drug therapy
  • Editorial

Vancomycin use in neonates and children: evidence-based practice is needed

  1. Elizabeth Starkey2
  1. 1Academic Division of Child Health, University of Nottingham, Derbyshire Children's Hospital, Derby, UK
  2. 2Derbyshire Children's Hospital, Derby, UK
  1. Correspondence to Dr Helen M Sammons, Academic Division of Child Health, Clinical, The Medical School, Derbyshire Children's Hospital, Uttoxeter Road, Derby, Derby DE22 3DT, UK; helen.sammons{at}
  • Received 13 December 2012
  • Revised 15 March 2013
  • Accepted 18 March 2013
  • Published Online First 16 April 2013

Vancomycin is an antibiotic that has been used in clinical practice for many years, but we have a situation where our current dosage regimen has been found to be insufficient to produce the recommended therapeutic levels. Timely studies, such as the one by Zhao et al,1 are working towards providing a firm evidence base for future recommendations. Vancomycin is the treatment of choice for methicillin resistant Staphylococcus aureus (MRSA). In Europe, it is used for the treatment of late-onset sepsis in neonates and in children, ventricular shunt or central venous catheter-associated infections. However, despite nearly 50 years of use there are still challenges around its dosage in both the neonatal and childhood populations.


The paper by Zhao et al1 represents a logical investigation into the issues surrounding vancomycin dosage in neonates. Recent work has shown large variability in practice across units in dose, frequency and timing of therapeutic drug monitoring levels (TDM).2 In the neonatal population, vancomycin is used in an intensive care setting, and so the use …