Variation in vancomycin dosing and therapeutic drug monitoring practices in neonatal intensive care units

Anouk van der Veen, Annemie Somers, Sophie Vanhaesebrouck, Rob ter Heine, Roger Brüggemann, Karel Allegaert, Pieter De Cock

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


Background Vancomycin is a frequently used antibiotic in neonates. However, there is no consensus guideline on the optimal dosing regimen and therapeutic drug monitoring (TDM) practices in this patient population. Objective To document the variability in the current dosing and TDM practices in neonatal intensive care units (NICU). Setting Belgian and Dutch NICUs. Method An online questionnaire was disseminated by e-mail to potential respondents. Main outcome measure Differences in vancomycin dosing and TDM practices in comparison with a reference source, the Dutch Paediatric Formulary. Results Eighteen NICUs (response rate 62%) participated. Eleven different dosing regimens are applied, with 83% using intermittent dosing regimens. Stratifying covariates used to determine the (initial) dosage include gestational age, postnatal age, serum creatinine, concurrent use of non-steroidal anti-inflammatory drugs, birth weight and current weight. Large variability is observed with regard to TDM practice as well, both for the concentration target range and the times of (re)sampling. Dosing calculators are more commonly used in the Netherlands than Belgium. Conclusion Significant inter-centre variability in dosing and TDM practices was found. The development of international consensus guidelines is required to optimize therapy. Dosing calculators to guide dosing are not yet considered as part of standard-of-care.

Original languageEnglish
Pages (from-to)564-569
Number of pages6
JournalInternational Journal of Clinical Pharmacy
Issue number2
Publication statusPublished - Apr 2022
Externally publishedYes


  • Antibiotic policy
  • NICU
  • Therapeutic drug monitoring
  • Vancomycin
  • Drug Monitoring/methods
  • Anti-Bacterial Agents
  • Intensive Care Units, Neonatal
  • Humans
  • Child
  • Gestational Age
  • Infant, Newborn


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