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Abstract

Background: Due to the increasing resistance of staphylococcal strains, vancomycin is often used as empiric therapy in neonatal late-onset sepsis. The Infectious Disease Society of America 2011 methicillin-resistant Staphylococcus aureus guidelines recommended that vancomycin's goal serum trough level concentration be increased from 5-10 mg/L to 10 to 20 mg/L in children and adults. Neonatal references have also recommended these target levels but dosing recommendations remained the same as previous. Aim: assessment of the percentage of neonates attaining a serum trough level between 10 and 20 mg/L with empiric vancomycin dosing in neonatal care unit patients and the evaluation of clinical outcomes and adverse drug events in relation to initial trough level. Patients and methods: A prospective cohort study was conducted in the neonatal care unit of Children Welfare Teaching Hospital of Medical City on 43 patients (neonates) during the period from 27th of January 2020 through 15th of December 2020. Patients included were treated with vancomycin and received a minimum of three doses. Results: Of the 43 vancomycin serum trough levels included in the primary outcome, only 14 (32.6%) achieved a goal trough of 10 to 20 mg/L with empiric dosing. Overall, vancomycin trough values below 10 mg/L were significantly associated with lower gestational age (<37 weeks) (P value 0.0394). No statistically significant difference between the group of patients who achieved a trough of greater Than 10 mg/L and those who did not in terms of hospital stay and mortality Conclusion: The initial vancomycin dosing regimens result in low attainment of vancomycin trough levels between 10–20 mg/L in neonates. However, the trough level does not predict mortality or clinical outcomes in patients with culture-confirmed late-onset sepsis.

DOI

10.52573/ipmj.2025.145527

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