{
  "abstract": "Background and Importance Vancomycin is a glycopeptide used to treat Gram-positive bacterial infections. Failure to achieve therapeutic levels or toxicity may require switching to alternative treatments. Few studies have been published addressing this situation in the paediatric population.Aim and Objectives To describe paediatric patients treated with vancomycin who required switching to another antibiotic, and to assess whether these modifications were justified.Material and Methods A descriptive, observational, retrospective study was conducted in hospitalised paediatric patients treated with intravenous vancomycin between 01 January 2022 and 31 July 2024, who later switched to another antibiotic for the same indication. Data were obtained from medical records and the prescribing program. Changes were considered justified if vancomycin doses exceeded 75 mg/kg/day without achieving trough levels of 10–15 mg/mL, in central nervous system infections, or in clinically unstable patients. The protocol was approved by the local ethics committee.Results A total of 836 vancomycin treatments were administered to 582 patients. Treatment was changed in 69 cases (62 patients). Median age was 4.4 years (1 month–19.5 years); 61% were male and 82% had underlying diseases (51 patients), mostly oncohaematological (30). The most frequent indications were bacteraemia (32%), febrile neutropenia (12%), prophylaxis (7%), fever of unknown origin (6%), and pneumonia (6%).Vancomycin was switched to linezolid in 40 treatments (58%), daptomycin in 24 (35%), clindamycin in 4 (6%), and ceftaroline in 1. The main reason for switching was failure to reach therapeutic levels (52%, 36 treatments), although 14 were deemed unjustified since maximal dosing had not been attempted (mean dose 62 mg/kg/day). Fifteen treatments (22%) were switched due to sequential step-down to oral therapy, although in three cases a more suitable antibiotic could have been chosen. 14 treatments (20%) were changed due to the patient’s clinical condition, although in two cases doses could have been increased. In one case, antibiogram-guided selection was preferable. Four treatments (6%) were changed due to allergy or adverse effects.Conclusion and Relevance Vancomycin is mainly used in preschool children with oncohaematological diseases. Most changes were justified, but serum level monitoring and dose optimisation are crucial before switching. Antibiotic choice should be guided by susceptibility results to ensure appropriate management in paediatric patients.Conflict of Interest No conflict of interest",
  "authors": [
    {
      "affiliations": [
        "Hospital Infantil Universitario Niño Jesús, Pharmacy, Madrid, Spain"
      ],
      "name": "B Riva De La Hoz"
    },
    {
      "affiliations": [
        "Hospital Infantil Universitario Niño Jesús, Pharmacy, Madrid, Spain"
      ],
      "name": "M Echávarri De Miguel"
    },
    {
      "affiliations": [
        "Hospital Infantil Universitario Niño Jesús, Paediatric Department, Madrid, Spain"
      ],
      "name": "FJ Martínez Álvarez"
    },
    {
      "affiliations": [
        "Hospital Infantil Universitario Niño Jesús, Paediatric Department, Madrid, Spain"
      ],
      "name": "C Pascual Alonso"
    },
    {
      "affiliations": [
        "Hospital Infantil Universitario Niño Jesús, Paediatric Department, Madrid, Spain"
      ],
      "name": "O Carmona Abellan"
    },
    {
      "affiliations": [
        "Hospital Infantil Universitario Niño Jesús, Pharmacy, Madrid, Spain"
      ],
      "name": "E Algarra"
    },
    {
      "affiliations": [
        "Hospital Infantil Universitario Niño Jesús, Pharmacy, Madrid, Spain"
      ],
      "name": "A Merino Pardo"
    },
    {
      "affiliations": [
        "Hospital Infantil Universitario Niño Jesús, Pharmacy, Madrid, Spain"
      ],
      "name": "B Leal Pino"
    },
    {
      "affiliations": [
        "Hospital Infantil Universitario Niño Jesús, Pharmacy, Madrid, Spain"
      ],
      "name": "L Fernández Romero"
    },
    {
      "affiliations": [
        "Hospital Infantil Universitario Nino Jesús, Department of Infectious Disease, Madrid, Spain"
      ],
      "name": "MT García Ascaso"
    },
    {
      "affiliations": [
        "Hospital Infantil Universitario Niño Jesús, Pharmacy, Madrid, Spain"
      ],
      "name": "M Cuervas-Mons Vendrell"
    }
  ],
  "title": "4CPS-023 From vancomycin to alternatives: drivers of therapy change in children",
  "uid": "6f74f7fd-0ed2-5ee0-a56a-012a52343fcd"
}