ISSN: 1859 - 2872
Population pharmacokinetic modeling and dosing simulation of vancomycin in pediatric patients at Vinmec International Hospital
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Abstract
Objective: This study aimed to develop a population pharmacokinetic (popPK) model for vancomycin in pediatric patients at Vinmec International Hospital and propose the optimal dosage regimen. Subject and method: Pediatric patients who received vancomycin for ≥ 48 hours and had at least one steady-state concentration were included. PopPK modeling was performed using Monolix2021R2 with a one-compartment model and first-order kinetics to estimate clearance (Cl) and volume of distribution (Vd). The individual parameters Cl, Vd was a log-normal distribution within the population. Prior to exploring potential covariates, these parameters were scaled by weight using an allometric approach. Monte Carlo simulation (n = 1000) was conducted to evaluate the probability of PK/PD target attainment for different dosing regimens. Result: Twenty-seven patients and 61 vancomycin concentrations were analysed. Median age was 3.4 years (IQR 2.1-7.8) and mean baseline eGFR was 206.2 ± 79.5mL/min/1.73m2. The final model with propotional residual error adequately described vancomycin pharmacokinetics. Age and eGFR were significant covariates for Cl vancomycin. Simulations suggested that 60mg/kg/day was sufficient for patients with eGFR < 90mL/min/1.73m2, while higher doses (75 - 90mg/kg/day) may be required for those with normal or increased renal function. Conclusion: The developed vancomycin popPK model faciliated optimized vancomycin dosing in pediatric patients at the hospital.
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References
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