BACKGROUND: There is no consensus on vancomycin dosing in newborns and young 
infants.
OBJECTIVE: The first objective was to assess the efficiency of a simplified 
dosing regimen with a cohort study. The secondary objective was to examine 
pharmacokinetic data to determine how this simplified dosing could be improved.
METHODS: All neonates admitted to our intensive care unit and treated with 
vancomycin were included in the pharmacokinetic study (PK group, 83 treatments, 
156 measurements). The vancomycin dosing regimen consisted of a loading dose of 
7 mg/kg, followed by a constant continuous dose of 30 mg/kg/day. The target 
serum vancomycin concentration ranged from 10 mg/l to 30 mg/l. Data from 
patients whose medications followed the scheduled dosing without modifications 
or prescription errors (actual dosing group: 62 treatments, 108 measurements) 
were analysed separately. A population pharmacokinetic analysis was performed 
(PK group) to simulate several vancomycin dosings.
RESULTS: Prescription errors were found in 10 of 83 treatments (12%). In the 
actual dosing group, 89.2% of vancomycin measurements were within the target 
range. Serum creatinine remained stable throughout treatment. Vancomycin 
concentrations varied widely. The modified regimen for a target vancomycin 
concentration of 25 mg/l consisted of a bolus of 20 mg/kg followed by continuous 
infusion of 30 mg/kg.
CONCLUSION: Our pharmacokinetic data and bedside results suggest that a 
simplified schedule of vancomycin can achieve the targeted drug concentrations 
in most patients while avoiding secondary renal toxicity. The proposed new 
dosing scheme should be validated in a drug survey, but due to pharmacokinetic 
variability, still requires therapeutic drug monitoring.