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Optimizing Vancomycin Regimen in Children with MRSA Infections Based on PK/PD Model and Monte Carlo Simulation

??OBJECTIVE To optimize vancomycin regimen in children with MRSA infection. METHODS Vancomycin AUC_0-24/MIC predictions were performed across a range of dosages (20-70 mg??kg^-1??d^-1) using a Monte Carlo simulation (n=10 000). AUC_0-24 was calculated as daily dose divided by vancomycin clearance, and daily dose was fixed for a given simulation. The MIC distribution for MRSA was obtained from the RESULTS of clinical laboratory, the First Affiliated Hospital of Guangxi Medical University, from 2012 to 2014 (n=430;30%??0.5 mg??L^-1; 58.6%= 12 mg??L^-1; and 11.2%=2 mg??L^-1; 0.2%=4 mg??L^-1). RESULTS With increasing vancomycin daily dose, the percentage of patients predicted to achieve AUC_0-24/MIC >400 similarly increased. At 35 mg??kg^-1??d^-1, the percentage predicted to achieve AUC_0-24/MIC >400 was 99.41% when MIC was 0.5 mg??L^-1. However, the dosage rose to 65 mg??kg^-1??d^-1 when MIC was 1 mg??L^-1. At this regimen, the percentage predicted to achieve AUC_0-24/MIC >400 was 97.55%. At a MIC of 2 mg??L^-1 and more, none of the dosages predicted to achieve AUC_0-24/MIC>400. CONCLUSION Recommended empiric vancomycin dosing in children should be above 35 mg??kg^-1??d^-1 when MIC is 0.5 mg??L^-1. At the MIC is 1 mg??L^-1, the recommended regimen should be over 65 mg??kg^-1??d^-1.