Vancomycin pharmacokinetics and dosing in premature neonates

Ther Drug Monit. 1995 Aug;17(4):319-26. doi: 10.1097/00007691-199508000-00001.


We prospectively studied the pharmacokinetic parameters of vancomycin in premature neonates given vancomycin according to a dosage protocol developed in our neonatal unit. Study infants were administered vancomycin according to four postconceptional age (PCA) groups: (0) 18 mg/kg every 36 h for PCA < 27 weeks; (I) 16 mg/kg every 24 h for PCA 27-30 weeks; (II) 18 mg/kg every 18 h for PCA 31-36 weeks; and (III) 15 mg/kg every 12 h for PCA > or = 37 weeks. Pharmacokinetic parameters were calculated from peak and trough serum vancomycin concentrations at steady state. Results in 44 infants (PCA, 27-44 weeks) showed that our dosage regimen achieved target peak serum vancomycin concentrations in 64% of neonates in Groups I-III, although it tended to undershoot the target trough concentrations. Volume of distribution (Vd), normalized for body weight, remained constant throughout the PCA range, with a mean value of 0.56 L/kg, whereas absolute clearance (r = 0.81) and normalized clearance (r = 0.48) increased with PCA (p < 0.005). The increase in clearance with PCA is associated with a greater elimination rate constant and shorter half-life. Vancomycin therapy can be initiated in a standard fashion according to our protocol or by individualizing the dosage regimen based on a Vd of 0.56 L/kg and clearance estimated from the infant's body weight and PCA groups.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / pharmacokinetics*
  • Anti-Bacterial Agents / therapeutic use*
  • Drug Administration Schedule
  • Enterocolitis, Pseudomembranous / drug therapy
  • Humans
  • Infant, Newborn
  • Infant, Premature, Diseases / drug therapy*
  • Infant, Premature, Diseases / metabolism
  • Infusions, Intravenous
  • Sepsis / drug therapy
  • Staphylococcal Infections / drug therapy
  • Vancomycin / administration & dosage
  • Vancomycin / pharmacokinetics*
  • Vancomycin / therapeutic use*


  • Anti-Bacterial Agents
  • Vancomycin