Optimizing vancomycin regimen in children with mrsa infections based on PK/PD model and Monte Carlo simulation / 中国药学杂志

ABSTRACT

OBJECTIVE: To optimize vancomycin regimen in children with MRSA infection. METHODS: Vancomycin AUC0-24/MIC predictions were performed across a range of dosages (20-70 mg·kg-1·d-1) using a Monte Carlo simulation (n=10 000). AUC0-24 was calculated as daily dose divided by vancomycin clearance, and daily dose was fixed for a given simulation. The MIC distribution for MRSA was obtained from the RESULTS of clinical laboratory, the First Affiliated Hospital of Guangxi Medical University, from 2012 to 2014 (n=430;30%≤0.5 mg·L-1; 58.6%= 12 mg·L-1; and 11.2%=2 mg·L-1; 0.2%=4 mg·L-1). RESULTS: With increasing vancomycin daily dose, the percentage of patients predicted to achieve AUC0-24/MIC >400 similarly increased. At 35 mg·kg-1·d-1, the percentage predicted to achieve AUC0-24/MIC >400 was 99.41% when MIC was 0.5 mg·L-1. However, the dosage rose to 65 mg·kg-1·d-1 when MIC was 1 mg·L-1. At this regimen, the percentage predicted to achieve AUC0-24/MIC >400 was 97.55%. At a MIC of 2 mg·L-1 and more, none of the dosages predicted to achieve AUC0-24/MIC>400. CONCLUSION: Recommended empiric vancomycin dosing in children should be above 35 mg·kg-1·d-1 when MIC is 0.5 mg·L-1. At the MIC is 1 mg·L-1, the recommended regimen should be over 65 mg·kg-1·d-1.