Vancomycin Dose Prescribing Practices, Therapeutic Drug Monitoring, and Infusion-Related Histaminergic Reactions among Pediatric Patients
DOI:
https://doi.org/10.59644/oaphhar.4(2).278Keywords:
Vancomycin, Pediatric Patients, Therapeutic Drug Monitoring, Red Man Syndrome, Histaminergic Reactions, Drug SafetyAbstract
To review vancomycin use, therapeutic drug Monitoring (TDM) use, and to assess the incidence of “infusion-related” histaminergic reactions for children receiving vancomycin. This prospective observational study was conducted in the pediatric wards and the intensive care unit of a tertiary care hospital in Pakistan over a 12-month period from January to December 2024. Patients were included if they were pediatric (aged 1 month to 14 years) and received vancomycin intravenously for more than 48 hours. A structured form was used to collect data on dosing, trough level, time of sample collection, infusion rate, and adverse reactions. Chi-square test, “Fisher's exact test, and Mann-Whitney U test” were used; p-values less than 0.05 were considered statistically significant. A total of 137 pediatric patients were recruited. Subtherapeutic vancomycin levels were seen in all age groups. Infants had a significantly higher frequency of supratherapeutic levels (p = 0.006). The serum creatinine level was significantly associated with elevated trough level (p = 0.035). Histaminergic reactions, mostly those that are infusion-related, were seen in 20 patients (14.6%) and were associated with infusion procedures, not with IgE-mediated mechanisms. There is considerable variability in prescribing and poor compliance with the therapeutic drug Monitoring (TDM) guidelines. Better monitoring, appropriate timing of drug level testing, and dose tailoring are crucial to improve vancomycin therapy in children.
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