A Multicenter Retrospective Study of Vancomycin Dosing by Weight Measures in Children

Manaswitha Khare, Meredith B. Haag, Garrett Kneese, Jared P. Austin, Jeremy Perlman, Aniqa Azim, Carisse Orsi, Byron A. Foster

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: Vancomycin carries risks of treatment failure and emergent resistance with underexposure and renal toxicity with overexposure. Children with overweight or obesity may have altered pharmacokinetics. We aimed to examine how body weight metrics influence vancomycin serum concentrations and to evaluate alternative dosing strategies. METHODS: This was a multicenter retrospective cohort study across 3 large, academic hospitals. Patients aged 2 to 18 years old who received $3 doses of intravenous vancomycin were included. Weight metrics included total body weight, adjusted body weight, ideal body weight, body surface area, and allometric weight. Outcomes included vancomycin concentration and ratios of area under the curve (AUC) to minimum inhibitory concentration (MIC). Regression analyses were used to examine which body-weight identifier predicted outcomes. RESULTS: Of the 1099 children, 45% were girls, mean age was 9.0 (SD = 5.4) years, 14% had overweight, and 17% had obesity. Seventy-five percent of children had vancomycin concentrations in the subtherapeutic range by trough <10 mg/mL, and 63% had a ratio of AUC to MIC <400 lg-hr/mL. Three percent had a supratherapeutic initial trough >20 mg/mL or ratio of AUC to MIC >600 lg-hr/mL. Serum vancomycin concentrations were higher in children with overweight or obesity compared with children who were at a normal weight or underweight; the mean ratio of AUC to MIC also trended higher in the groups with overweight or obesity. CONCLUSIONS: Most children received vancomycin regimens that produced suboptimal trough levels. Children with overweight or obesity experienced higher vancomycin trough levels than children of normal weight despite receiving lower total body weight dosing. Using the ratio of AUC to MIC was a better measure of drug exposure.

Original languageEnglish (US)
Pages (from-to)E289-E296
JournalHospital pediatrics
Issue number11
StatePublished - Nov 2021

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pediatrics


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