Initial vancomycin dosing in pediatric oncology and stem cell transplant patients

J Pediatr Hematol Oncol. 2009 Jan;31(1):3-7. doi: 10.1097/MPH.0b013e31818b3520.


Background: Gram-positive bacteremia is a common infection in pediatric oncology and stem cell transplant (SCT) patients requiring therapy with vancomycin. Optimal dosing of vancomycin in this patient population has not been well established.

Methods: All pediatric oncology and SCT patients receiving vancomycin between October 2006 and March 2007 were included in this study. Therapeutic levels were defined as levels between 10 and 15 mg/dL and low therapeutic levels were between 5 and 9 mg/dL. Information regarding any recent or concurrent nephrotoxic medications was collected.

Results: Fifty-six patients received 82 courses of vancomycin during the study period. More patients (53.7%) received vancomycin for empiric therapy and 78% had recent or concurrent use of nephrotoxic medications. Using standardized vancomycin dosing guided by a computerized provider order entry system, there were significantly more patients who were in the subtherapeutic range than the supratherapeutic range (P=0.0023). There were also significantly more patients in the low therapeutic than the therapeutic range (P<0.0001). A small number of courses (3.5%) were associated with supratherapeutic levels. There was no association between the concurrent or recent use of nephrotoxic medications and vancomycin levels.

Conclusions: Pediatric oncology and SCT patients with normal renal function require higher daily vancomycin doses than other pediatric patients.

MeSH terms

  • Adolescent
  • Anti-Bacterial Agents / administration & dosage*
  • Bacteremia / drug therapy*
  • Bacteremia / etiology
  • Child
  • Child, Preschool
  • Dose-Response Relationship, Drug
  • Humans
  • Infant
  • Leukemia / therapy*
  • Retrospective Studies
  • Stem Cell Transplantation*
  • Transplantation, Homologous
  • Treatment Outcome
  • Vancomycin / administration & dosage*
  • Young Adult


  • Anti-Bacterial Agents
  • Vancomycin