Estefania Niewialkouski, DO
Physician PGY-3 Pediatrics
Salah Foundation Children's Hospital, Broward Health Medical Center
Fort Lauderdale, Florida, United States
Disclosure information not submitted.
Amanda Costa, MD
Physician PGY-3 Pediatrics
Salah Foundation Children's Hospital, Broward Health Medical Center
Fort Lauderdale, Florida, United States
Disclosure information not submitted.
Karla Dixon, MD
Physician PGY-3 Pediatrics
Salah Foundation Children's Hospital, Broward Health Medical Center
Fort Lauderdale, Florida, United States
Disclosure information not submitted.
Bibin Varughese, Pharm.D
Clinical Pharmacist
Salah Foundation Children's Hospital, Broward Health Medical Center
Fort Lauderdale, Florida, United States
Disclosure information not submitted.
Alejandro Isava, MD
Infectious Disease Physician
Salah Foundation Children's Hospital, Broward Health Medical Center
Fort Lauderdale, Florida, United States
Disclosure information not submitted.
Title: Evaluating Optimal Vancomycin Dosing Regimens in the Pediatric Sickle Cell Population
Introduction: Children with sickle cell disease are at increased risk of developing serious bacterial infections. Empiric combination of vancomycin and extended-spectrum cephalosporin therapy is indicated for life-threatening infections in this population. Achieving vancomycin therapeutic levels is essential for antibacterial success and resistance prevention. Our study hypothesizes that pediatric sickle cell disease will lead to increased renal clearance due to glomerular hyperfiltration that will require higher doses of vancomycin to reach therapeutic levels when compared to the general pediatric population.
Methods: A retrospective cohort chart review study of sickle cell pediatric patients (hemoglobin SS, hemoglobin SC, and sickle thalassemia) admitted to Salah Foundation Children's Hospital from 2016-2019 treated with vancomycin who had a steady state vancomycin trough level drawn was performed to evaluate the relationship between initial dose used and the resultant trough. Demographic factors (age, gender, height, and body weight), diagnoses, vancomycin-related details (dose, frequency, and duration), serum vancomycin levels, and creatinine were collected for each patient.
Results: A total of 781 individuals were involved in the study groups (Control=643, Sickle Cell Disease SC=49, Sickle Cell Disease SS =74 and Sickle Thalassemia N=15). A multivariable generalized linear model found significant differences between study groups controlling for subjects' age, baseline serum, baseline eGFR, daily dose, and increased dose, R2 = .24, F(df = 9; 94)= 3.24, p < .001. Specifically, Sickle Cell Disease SS subjects had significantly lower trough levels than control subjects. (difference = 4.77, 95% CI: 1.70,7.85, p < 0.001).
Conclusion: Our results demonstrate that the HgSS group has lower trough levels at the same drug dosages than the general population. This in turn can significantly increase the risk of mortality, as sickle cell patients may be given inadequate doses with the goal of achieving therapeutic vancomycin drug concentrations in the setting of life-threatening infections. As such, obtaining therapeutic trough concentrations without delay is imperative to optimizing a safe and effective care plan.