Analysis of the Implementation of Therapeutic Drug Monitoring-guided Vancomycin Dosing in Pediatric Patients at Duc Giang General Hospital

Abstract

Objectives: i) To describe vancomycin use and dose adjustments based on AUC estimated using a Bayesian approach in pediatric patients at Duc Giang General Hospital; and ii) To identify factors associated with the risk of AUC target non-attainment at the first TDM of vancomycin. Methods: A prospective study was conducted from March 2025 to September 2025. Neonatal and pediatric patients receiving intravenous vancomycin underwent TDM, and doses were adjusted to achieve the target AUC of 400–600 mg·h/L. AUC values were estimated using a Bayesian approach with SmartDoseAI® software. Multivariable logistic regression analysis was performed to identify factors associated with the risk of AUC target non-attainment. Results: A total of 70 pediatric patients were included. Target AUC attainment increased significantly from 41.4% to 84.3% after the first dosing adjustment. Overall, 92.9% of patients achieved the target AUC at least once during treatment. Multivariable logistic regression analysis showed that estimated glomerular filtration rate (eGFR/10 mL/min) was independently associated with both subtherapeutic exposure (AUC < 400 mg·h/L, OR = 1.45, p = 0.004) and supratherapeutic exposure (AUC > 600 mg·h/L, OR = 0.48, p < 0.001). Conclusion: AUC-guided vancomycin dosing using a Bayesian approach improved target attainment in pediatric patients. Baseline renal function and the initial maintenance dose should be considered to enhance the probability of early AUC target attainment.