Evaluation of the vancomycin dosage regimen based on serum creatinine used in the neonatal intensive care unit

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Background:Vancomycin is frequently used for the treatment of methicillin–resistant Staphylococcus aureus (MRSA) infections; however, determining the optimal dosage for neonates is difficult because of their immature renal function.Methods:Serum creatinine–based dosing was introduced in Kumamoto City Hospital Neonatal Medical Center. Serum trough concentration and therapeutic efficacy of vancomycin were evaluated before and after the introduction of the creatinine–based dosing.Results:When the therapeutic range of serum trough concentration of vancomycin at steady state was set to 5–15 μg/mL, 20 trough concentrations (48.8%) were within the therapeutic range and 21 trough concentrations were outside the therapeutic range before the introduction of the serum creatinine–based dosing. After the introduction of serum creatinine–based dosing, 18 trough concentrations (81.8%) were within the therapeutic range and 4 trough concentrations were not, and there was an increase in the number of patients with trough concentrations in the therapeutic range (P= 0.01; Fisher's exact test).Conclusions:The serum creatinine–based dosing of vancomycin is useful in maintaining the appropriate serum level of vancomycin in neonates.

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