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TREY CRUMBY, PHARM.D., is Clinical Pharmacy Coordinator, St. Mary’s Hospital, Rogers, AR, and Assistant Professor, Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock. ELIZA RINEHART, PHARMD., is Clinical. Pharmacist, Regional Medical Center at Memphis, Memphis, TN, and Assistant Professor, Department of Pharmacy, University of Tennessee Health Science Center, Memphis. MOLLIE CANNON CARBY, PHARMD.,. is Clinical Pharmacist, Blue Cross and Blue Shield of Louisiana, Baton Rouge. DAVID KUHL, PHARMD.,. is Professor and Chair, Pharmacy Practice, School of Pharmacy, Union University, Jackson, TN. AJAY J. TALATI, M.D., is Associate Professor, Department of Pediatrics and OB/GYN, University of Tennessee Health Science Center.

Address correspondence to Dr. Rinehart at the Regional Medical Center at Memphis, 877 Jefferson Avenue, Suite TT201, Memphis, TN 38103 (erinehart{at}the-med.org).

Purpose. This study compared steady-state concentrations achieved with a dosing strategy using first-dose kinetics to individualize vancomycin regimens with the steady-state concentrations achieved using standardized nomograms. Methods. Neonatal intensive care unit patients receiving vancomycin according to published nomograms (phase 1) were compared with patients receiving vancomycin using first-dose pharmacokinetic information to individualize the dosing regimen (phase 2). Retrospective chart review was used to gather demographic and patient-specific pharmacokinetic data. Data collected included gestational and postnatal ages, birth and dosing weights, first-dose peak and trough concentrations, serum creatinine, and information related to infection. Data were analyzed to determine the percentage of therapeutic concentrations at a steady state in each group. Results. Phase 1 included 108 patients given doses according to published nomograms, and phase 2 included 85 patients who received vancomycin with first-dose pharmacokinetics. Steady-state concentrations were collected in 108 patients in phase 1 and 39 patients in phase 2. Both peak and trough concentrations were therapeutic at steady state in 39% in phase 1 versus 63% in phase 2 (p < 0.02). Therapeutic steady-state peak concentrations were achieved in 70% versus 76% while therapeutic steady-state trough concentrations were achieved in 50% versus 82% (p < 0.02) in phase 1 and phase 2, respectively. Conclusion. Compared with the use of nomograms, individualization of vancomycin regimens after the first dose in neonatal patients significantly increased the percentage of patients with target steady-state trough concentrations and with both target peak and trough concentrations. The benefits of individualized dosing were attained without additional venous sampling. Index terms: Antibiotics; Blood levels; Dosage; Nomograms; Pediatrics; Pharmacokinetics; Vancomycin