Newborn infants with necrotising enterocolitis: No trial included use of vancomycin.[16]
Prevention of necrotising enterocolitis: Prophylactic oral vancomycin reduced the incidence of NEC in low birth weight infants. However concerns about adverse outcomes persist, particularly related to the development of resistant bacteria. [17, 18] [LOE II GOR D]
Therapeutic hypothermia (TH): There are no published data regarding the use of vancomycin during treatment with TH in neonates. A population pharmacokinetic study from children who were being treated with TH post cardiac arrest compared with normothermic controls indicated that in patients with normal renal function vancomycin clearance was reduced by 25%.27
ANMF group Recommendation: In infants being treated with TH measure a trough concentration immediately prior to the second dose.
Safety:
Risk factors for developing nephrotoxicity are the following: trough concentrations >10 mg/ml, concomitant treatment with aminoglycosides, piperacillin/tazobactam and/or prolonged therapy (>21 days).[1]
Other risk factors include high peak concentrations, high total dose, pre-existing renal failure, and concurrent treatment with amphotericin and/or furosemide. However, the role of these factors in the neonatal population is not well-established. Proper vancomycin TDM minimised both glomerular and tubular nephrotoxicity in two studies in children and neonates. In most cases, nephrotoxicity is reversible, even after high doses. In contrast, there is no proven association between TDM and ototoxicity prevention.[1]
Gwee et al 2018 [5] compared intermittent intravenous (IV) dosing using the British Neonatal Formulary (BNF) dosage guidance versus continuous IV [loading dose of 15 mg/kg over 1 hour then continuous infusion). No nephrotoxicity or red man syndrome occurred in either group.
|
