Influence of malignancy on the pharmacokinetics of vancomycin in infants and children

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This prospective, controlled study evaluates the influence of malignancy on the pharmacokinetics and dosage requirements of vancomycin in 33 infants and children with cancer (age 5.72 ± 4.11 years, mean ± SD) compared with 31 patients without cancer (age 4.18 ± 5.10 years) using a two-compartment Bayesian pharmacokinetic program. Patients in the malignancy group required a vancomycin dosage regimen of 71.5 ± 13.9 mg/kg/day to attain a mean peak serum vancomycin concentration (SVC) of 22.38 ± 4.54 mg/liter and a mean trough SVC of 6.84 ± 2.78 mgAiter. Patients without cancer in the control group required a mean vancomycin dosage regimen of 50.2 ± 13.0 mg/kg/day to attain a mean peak SVC of 21.70 ± 6.70 mg/liter and a mean trough SVC of 8.05 ± 3.01 mg/liter. Comparative analysis of pharmacokinetic data revealed an increase in vancomycin clearance (0.149 ± 0.028 liter/hour/kg) in the malignancy group as compared with that (0.114 ± 0.031 liter/hour/kg) in the control group. There were no significant differences with respect to the mean values of volume of distribution between two groups (0.638 ± 0.079 liter/kg vs. 0.618 ± 0.102 liter/kg). Analysis of the predictive performance of the Bayesian program indicated that final sets of peak and trough SVCs were predicted with minimal bias and accurate precision in both study groups.

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