Vancomycin pediatric patients

Serum drug concentrations should be monitored for drugs with narrow therapeutic indices and ehminated largely by the kidney (e.g., aminoglycosides and vancomycin) to optimize therapy in pediatric patients with renal dysfunction. For drugs with wide therapeutic ranges (e.g., penicillins and cephalosporins), dosage adjustment may be necessary only in moderate to severe renal failure. 

Routine use of dexamethasone in meningitis is not without controversy. A potential concern is that adjunctive dexamethasone therapy might reduce the penetration of antibiotics into the CSF by inhibiting meningeal inflammation. In experimental models of meningitis, steroids decreased the CSF concentrations of ampiciUin, rifampin, vancomycin, and gentamicin. Ceftriaxone penetration into CSF was unaffected by concurrent dexamethasone administration in pediatric patients. ... 

Vancomycin hydrochlo- Pediatric dose penicillin 200,000 units/kg per 24 hours IV in tour to six equally divided doses ceftriaxone 100 mg/kg per 24 hours IV/IM in one dose gentamicin 3 mtf kg per 24 hours IV/IM in one dose or three equally divided doses 30 m kg per 24 hours IV in two equally divided doses not to exceed 2 4 IB (second option to single daily dose) Vancomycin therapy recommended only for patients unable to tolerate... 

Dosages recommended are for patients with normal renal function See Table 37-3 for appropriate dosage of gentamicin "Pediatric dose should not exceed that of a normal adult See text and Table 37-3 for appropriate dosage of vancomycin... 

AkU lO, Mir S. Hemodiafiltration for vancomycin overdose in a patient with end-stage renal failure. Pediatr Nephrol 2001 16(12) 1019-21. 

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