Preoperative Vancomycin Administration for Surgical Site Prophylaxis: Plasma and Soft-Tissue Concentrations in Pediatric Neurosurgical and Orthopedic Patients.

摘要: Background Vancomycin is used for antibiotic prophylaxis in pediatric surgical patients without a complete understanding of plasma and soft-tissue pharmacokinetics. Guidelines recommend incision within 60 minutes after administration; however, tissue vancomycin concentrations at that early time may not be therapeutic. We conducted study skin neurosurgical orthopedic to characterize intraoperative Methods Patients (0.1-18.8 years age) undergoing posterior spinal fusion (n = 30) or ventriculoperitoneal shunt placement received intravenous 15 mg/kg (maximum 1000 mg) over 1 hour. Skin was biopsied closure. Blood samples were collected incision, 2 4 hours intraoperatively, Population pharmacokinetic analysis performed parameter estimates develop model versus time. Results Pharmacokinetic included data from 59 subjects, 130 samples, 107 samples. A 2-compartment model, volume the central (Vc) peripheral compartment (V2), proved have best fit. Stepwise covariate selection yielded significant relationship body surface area on elimination clearance weight V2. rose continuously during surgery. Modeling predicted equilibration took ≥5 hours. Conclusions immediately preoperative dose are relatively low compared with end It advisable extend between if higher desired start