Use of vancomycin in pediatric patients with congenital heart disease at Queen Sirikit Heart Center of The Northeast Khon Kaen University
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Abstract
Background: Congenital heart disease (CHD) is a defect in the structure of the heart and great vessels which is present at birth. The CHD is high risk of infection such as infective endocarditis (IE) and postoperative septic complications from cardiac surgery. One of microorganism is methicillin-resistant S. Aureus (MRSA). Vancomycin is use in MRSA infection resistant to penicillin. Vancomycin also has narrow therapeutic index, many adverse drug reactions and is is expensive medication so in this study was studies utility of vancomycin in the pediatric patients with congenital heart disease i.e. indication, dosage and interval, therapeutic drug monitoring, adverse drug reactions and outcome also has been used in the pediatric patients with congenital heart disease at Queen Sirikit Heart Center of The Northeast Khon Kean University. Method: The data was retrospectively collected from inpatients medical record who received vancomycin at Queen Sirikit Heart Center of The Northeast Khon Kean University. Inclusion criterias are congenital pediatric patients age from 0 to 18 years old who received vancomycin and can be searched for inpatient medical record. Exclusion criteria are patient who can not searched for inpatient medical record and do not utility of vancomycin in inpatient medical record for 2 years. Results were shown in frequency and percentage. The study was approved from the Helsinki of the clinical ethics committee of Khon Kaen University. Result: Vancomycin was used in 137 patients but only 86 patients were recruited into the study. Indications were documented therapy and prophylaxis of 7.0% and 3.5%, respectively. On the other hand, unevaluated indications were 61.6% and 27.9% respectively. Dosage and interval, rate of administration and fluids were appropriate in 82.6%, 96.5% and 57.0%, respectively. Appropriate duration was reported to be 95.3%. Therapeutic drug monitoring (TDM) have been prescribed in the patients i.e.complete blood count, serum creatinine, vancomycin level, blood pressure, body temperature and urinalysis of 76.7%, 75.6%, 57.0%, 93.0%, 95.4% and 43.3%, respectively. Adverse drug reactions were occurred thrombocytopenia, nephrotoxicity and neutropenia of 17.7%, 7.0% and 1.2%, respectively. Patients were treated by monotherapy and combination therapy of 51.2% and 48.8%, respectively. The treatment is equally improve of 36.0%. Conclusion: This study found most of indications which are sepsis, acute febrile illness and pneumonia of 61.6%. Appropriate dose, administration of vancomycin in rate, duration and diluent. Therapeutic drug monitoring prescribed in most of patients. Although adverse drug reactions has low but should be close monitoring vancomycin for most effectiveness less adverse drug reaction and suitable for each patient. Keyword: Vancomycin, Congenital heart disease, pediatrics
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