Aims In 2008, the BNF for children changed their target range from 5–10 mg/l to 10–15 mg/l secondary to recommendations from the Special Advisory Committee on Antimicrobial Resistance. The dosing regimen of 15 mg/kg eight hourly did not change. The aim was to establish whether levels were therapeutic according to the dosing in the BNFc.
Methods A drug chart and case note audit was performed on infants and children started on vancomycin in a tertiary paediatric hospital between January and June 2010. Patients were excluded if less than 35 weeks postmenstrual age or had renal disease.
Results 36 infants and children with 43 different episodes, with a median age 2 years 9 months (range 11 days to 15 years) were included (figure 1). 44% received vancomycin for presumed line sepsis, 26% for sepsis, 14% for cardiorespiratory infections, 9% for neurosurgical infections and 7% for wound infections. 23% had positive microbiology. 95% (41/43) of episodes had one or more levels performed. First vancomycin levels showed, 76% were sub therapeutic (<10 mg/l), 12% were in the normal range (10–15 mg/l) and 12% levels were high (> 15 mg/l). 68% of episodes went on to have second levels of which, 68% were sub therapeutic, 25% therapeutic and 7% had high levels. 46% of episodes required third levels with 74% of these being low, 16% being in the normal range and 10% having high levels. Median time to get therapeutic was 5.4 days (range 3–19 days) however, 46% episodes never got into drug therapeutic range using the 10–15 mg/l range.
Conclusion 74% of all vancomycin levels taken were sub therapeutic using the current BNFc dosing regimen. This audit highlights that the BNFc dosing regimen is ineffective at producing satisfactory vancomycin levels to current recommendations. Therefore further research is needed to change the existing vancomycin dosing.
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