{
  "abstract": "Aim This study evaluated the impact of a revised local protocol on achieving therapeutic vancomycin levels when administered by intermittent infusion in neonatal critical care. Vancomycin, widely used in neonates, requires therapeutic drug monitoring to ensure efficacy and minimise toxicity; however, there is no standard approach to prescribing. A new protocol was introduced following a 2021 audit that revealed frequent suboptimal levels and delays in reaching target levels. 1 Following the 2021 audit, the corrected gestational age (CGA) based dosage instructions and the target range for levels were changed. Dosage instructions were now given for <33 and >33 weeks CGA, and the target range changed from 10-20mg/L to 15-20mg/L.Method A prospective audit across 2024-2025 reviewed 12 months of admissions to a Level 3 neonatal critical care unit. All courses of intermittent vancomycin infusions were included; vancomycin continuous infusions and single doses were excluded. Data were collected for the proportion of vancomycin trough levels within the target range (15-20mg/L), distribution of levels outside target, and time from treatment initiation to the first in-range trough level. Results were compared with the 2021 audit.Results In the 2024-2025 audit, 737 doses of vancomycin were administered across 48 treatment courses compared to 659 doses over 82 courses in 2021. A total of 185 trough levels were measured in 2024/25, compared to 190 in 2021.In 2024/25, 54/185 trough levels (29%) were within target range, compared to 70/190 (37%) in 2021.Levels by CGA in 2024 were as follows: <33 weeks (n=143): 30% in range, 45% low, 25% high; >33 weeks (n=44): 27% in range, 61% low, 12% high.In 2021, levels by CGA were: <29 weeks (n=38): 3% in range, 97% low, 0% high; 29–35 weeks (n=90): 39% in range, 56% low, 5% high; >35 weeks (n=62): 55% in range, 37% low, 8% highThe range of levels in 2024/25 was 4.1–39.1 mg/L: undetectable, 0%; 4–9.9 mg/L, 19%; 10–14.9 mg/L, 50%; 15–20 mg/L, 29%; 20.1–24.9 mg/L, 20%; >25 mg/L, 11%.In 2021, levels ranged from undetectable to 128 mg/L: undetectable, 16%; 4–9.9 mg/L, 41%; 10–20 mg/L, 37%; 20.1–24.9 mg/L, 4%; >25 mg/L, 2%.In 2024, 69% of treatment courses achieved at least one therapeutic level, with a mean time of 73 hours to the first in-range level, compared to 46% of courses and 31 hours in 2021.Conclusion Despite the new protocol, a significant proportion of vancomycin levels remain outside the target range; however, variability between CGA groups has reduced, indicating more consistent dosing performance. The overall range of measured levels has narrowed, with the elimination of undetectable levels and fewer extreme highs. Encouragingly, a greater proportion of courses now achieve at least one therapeutic level, albeit with longer time to reach target. These findings support consideration of alternative dosing strategies, including continuous vancomycin infusion or adopting teicoplanin as the first-line glycopeptide in neonatal care.Reference Chadwick C. P02 Optimising vancomycin use: a retrospective audit of neonatal vancomycin infusion therapy. BMJ Paediatrics Open. 2025;9:. https://doi.org/10.1136/bmjpo-2025-NPPG.12",
  "authors": [
    {
      "affiliations": [
        "University Hospitals Sussex, UK"
      ],
      "name": "Christian Chadwick"
    }
  ],
  "title": "P34 Optimising vancomycin use: audit of a new protocol for neonatal vancomycin infusions",
  "uid": "8d226af7-195c-5e80-93ef-7f5e1be2bf13"
}