{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:17:10Z","timestamp":1779927430150,"version":"3.53.1"},"reference-count":36,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,4,1]]},"abstract":"\n CONTEXT:<\/jats:title>\n Vancomycin is a medication with potential for significant harm with both overdosing and underdosing. Obesity may affect vancomycin pharmacokinetics and is increasingly common among children.<\/jats:p>\n <\/jats:sec>\n \n OBJECTIVE:<\/jats:title>\n We aimed to determine if children with overweight or obesity have increased vancomycin trough concentrations with total body weight (TBW) dosing compared with children with normal weight.<\/jats:p>\n <\/jats:sec>\n \n DATA SOURCES:<\/jats:title>\n We conducted a search of Medline and Medline In-Process & Other Non-Indexed Citations from 1952 (the year vancomycin was discovered) to November 2017.<\/jats:p>\n <\/jats:sec>\n \n STUDY SELECTION:<\/jats:title>\n Search terms included vancomycin, body weight, and body composition terms and were limited to children. Studies were reviewed and screened by \u22652 reviewers.<\/jats:p>\n <\/jats:sec>\n \n DATA EXTRACTION:<\/jats:title>\n The primary outcome was vancomycin level. Data were extracted by 2 reviewers. We performed quality assessment using the Newcastle-Ottawa quality assessment scale.<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n We identified 271 records. After abstract and full-text screening, we identified 7 studies for full review. Six of the 7 studies used a matched case-control design, although there was significant variation in study methodology. Four of the 7 studies were included in a meta-analysis, which revealed a small but significant difference in vancomycin trough levels between children with normal weight and children with overweight or obesity when dosed by using TBW (N = 521; mean difference 2.2 U [95% confidence interval: 1.0\u20133.4]).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n High-quality data to guide vancomycin dosing in children with obesity are lacking. More studies evaluating dosing strategies in children with obesity are warranted because using TBW to dose vancomycin may lead to higher vancomycin concentrations and potential toxicity.<\/jats:p>\n <\/jats:sec>","DOI":"10.1542\/hpeds.2019-0287","type":"journal-article","created":{"date-parts":[[2020,4,1]],"date-time":"2020-04-01T13:15:28Z","timestamp":1585746928000},"page":"359-368","source":"Crossref","is-referenced-by-count":7,"title":["Vancomycin Dosing in Children With Overweight or Obesity: A Systematic Review and Meta-analysis"],"prefix":"10.1542","volume":"10","author":[{"given":"Manaswitha","family":"Khare","sequence":"first","affiliation":[{"name":"Department of Pediatrics, University of California, San Diego, San Diego, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aniqa","family":"Azim","sequence":"additional","affiliation":[{"name":"School of Medicine, Oregon Health and Science University, Portland, Oregon; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garrett","family":"Kneese","sequence":"additional","affiliation":[{"name":"School of Medicine, Oregon Health and Science University, Portland, Oregon; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meredith","family":"Haag","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelsey","family":"Weinstein","sequence":"additional","affiliation":[{"name":"School of Medicine, Oregon Health and Science University, Portland, Oregon; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyung E.","family":"Rhee","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of California, San Diego, San Diego, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Byron Alexander","family":"Foster","sequence":"additional","affiliation":[{"name":"School of Medicine, Oregon Health and Science University, Portland, Oregon; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2020,4,1]]},"reference":[{"issue":"9727","key":"2021120817332513100_B1","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1016\/S0140-6736(10)60171-7","article-title":"Childhood obesity","volume":"375","author":"Han","year":"2010","journal-title":"Lancet"},{"issue":"21","key":"2021120817332513100_B2","doi-asserted-by":"crossref","first-page":"2292","DOI":"10.1001\/jama.2016.6361","article-title":"Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014","volume":"315","author":"Ogden","year":"2016","journal-title":"JAMA"},{"issue":"9","key":"2021120817332513100_B3","doi-asserted-by":"crossref","first-page":"1897","DOI":"10.1016\/j.clinthera.2015.05.495","article-title":"Pediatric obesity: pharmacokinetics and implications for drug dosing","volume":"37","author":"Kendrick","year":"2015","journal-title":"Clin Ther"},{"issue":"3","key":"2021120817332513100_B4","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1002\/phar.1899","article-title":"Pediatric obesity: pharmacokinetic alterations and effects on antimicrobial dosing","volume":"37","author":"Natale","year":"2017","journal-title":"Pharmacotherapy"},{"issue":"11","key":"2021120817332513100_B5","doi-asserted-by":"crossref","first-page":"984","DOI":"10.3928\/01477447-20061101-08","article-title":"Pharmacokinetic alterations in obesity","volume":"29","author":"Lee","year":"2006","journal-title":"Orthopedics"},{"issue":"7","key":"2021120817332513100_B6","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1001\/jamapediatrics.2015.132","article-title":"Drug dosing and pharmacokinetics in children with obesity: a systematic review [published correction appears in JAMA Pediatr. 2015;169(12):1179]","volume":"169","author":"Harskamp-van Ginkel","year":"2015","journal-title":"JAMA Pediatr"},{"issue":"3","key":"2021120817332513100_B7","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1093\/cid\/cir034","article-title":"Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary","volume":"52","author":"Liu","year":"2011","journal-title":"Clin Infect Dis"},{"issue":"3","key":"2021120817332513100_B8","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1016\/j.jpeds.2010.08.019","article-title":"Incidence and risk factors influencing the development of vancomycin nephrotoxicity in children","volume":"158","author":"McKamy","year":"2011","journal-title":"J Pediatr"},{"issue":"8","key":"2021120817332513100_B9","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1592\/phco.27.8.1081","article-title":"Antimicrobial dosing considerations in obese adult patients","volume":"27","author":"Pai","year":"2007","journal-title":"Pharmacotherapy"},{"issue":"5","key":"2021120817332513100_B10","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1542\/hpeds.2014-0081","article-title":"An evaluation of vancomycin dosing for complicated infections in pediatric patients","volume":"5","author":"Durham","year":"2015","journal-title":"Hosp Pediatr"},{"issue":"12","key":"2021120817332513100_B11","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.1002\/phar.1345","article-title":"Vancomycin dosing in children and young adults: back to the drawing board","volume":"33","author":"Camaione","year":"2013","journal-title":"Pharmacotherapy"},{"issue":"3","key":"2021120817332513100_B12","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1002\/phar.1552","article-title":"Assessment of initial serum vancomycin trough concentrations and their association with initial empirical weight-based vancomycin dosing and development of nephrotoxicity in children: a multicenter retrospective study","volume":"35","author":"Matson","year":"2015","journal-title":"Pharmacotherapy"},{"issue":"12","key":"2021120817332513100_B13","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1002\/phar.1321","article-title":"Vancomycin trough concentrations in overweight or obese pediatric patients","volume":"33","author":"Heble","year":"2013","journal-title":"Pharmacotherapy"},{"issue":"5","key":"2021120817332513100_B14","doi-asserted-by":"crossref","first-page":"2601","DOI":"10.1128\/AAC.03147-14","article-title":"Optimizing the clinical use of vancomycin","volume":"60","author":"\u00c1lvarez","year":"2016","journal-title":"Antimicrob Agents Chemother"},{"issue":"2","key":"2021120817332513100_B15","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1128\/AAC.01568-12","article-title":"Systematic review and meta-analysis of vancomycin-induced nephrotoxicity associated with dosing schedules that maintain troughs between 15 and 20 milligrams per liter","volume":"57","author":"van Hal","year":"2013","journal-title":"Antimicrob Agents Chemother"},{"issue":"2","key":"2021120817332513100_B16","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1002\/jcph.402","article-title":"Pediatric vancomycin dosing: trends over time and the impact of therapeutic drug monitoring","volume":"55","author":"Balch","year":"2015","journal-title":"J Clin Pharmacol"},{"issue":"1","key":"2021120817332513100_B17","first-page":"341","article-title":"A prospective study to assess vancomycin serum concentrations in pediatric patients with current dosing guidelines","volume":"15","author":"Arfa","year":"2016","journal-title":"Iran J Pharm Res"},{"issue":"7","key":"2021120817332513100_B18","doi-asserted-by":"crossref","first-page":"e1000100","DOI":"10.1371\/journal.pmed.1000100","article-title":"The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration","volume":"6","author":"Liberati","year":"2009","journal-title":"PLoS Med"},{"issue":"1","key":"2021120817332513100_B19","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1002\/jrsm.1077","article-title":"Checklists of methodological issues for review authors to consider when including non-randomized studies in systematic reviews [published correction appears in Res Synth Methods. 2013;4(3):287\u2013289]","volume":"4","author":"Wells","year":"2013","journal-title":"Res Synth Methods"},{"issue":"246","key":"2021120817332513100_B20","first-page":"1","article-title":"2000 CDC growth charts for the United States: methods and development","author":"Kuczmarski","year":"2002","journal-title":"Vital Health Stat 11"},{"issue":"5","key":"2021120817332513100_B21","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1177\/0009922810393500","article-title":"Vancomycin dosing in obese pediatric patients","volume":"50","author":"Moffett","year":"2011","journal-title":"Clin Pediatr (Phila)"},{"issue":"12","key":"2021120817332513100_B22","doi-asserted-by":"crossref","first-page":"1264","DOI":"10.1002\/phar.1331","article-title":"The effect of age and weight on vancomycin serum trough concentrations in pediatric patients","volume":"33","author":"Madigan","year":"2013","journal-title":"Pharmacotherapy"},{"issue":"6","key":"2021120817332513100_B23","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1016\/j.clinthera.2015.05.006","article-title":"Bayesian estimation of vancomycin pharmacokinetics in obese children: matched case-control study","volume":"37","author":"Le","year":"2015","journal-title":"Clin Ther"},{"issue":"5","key":"2021120817332513100_B24","doi-asserted-by":"crossref","first-page":"375","DOI":"10.2174\/157488612805076606","article-title":"Prospective evaluation of the dosing regimen of vancomycin in children of different weight categories","volume":"7","author":"Nassar","year":"2012","journal-title":"Curr Drug Saf"},{"issue":"3","key":"2021120817332513100_B25","first-page":"182","article-title":"Vancomycin dosing in healthy-weight, overweight, and obese pediatric patients","volume":"19","author":"Eiland","year":"2014","journal-title":"J Pediatr Pharmacol Ther"},{"issue":"21","key":"2021120817332513100_B26","doi-asserted-by":"crossref","first-page":"2062","DOI":"10.2146\/ajhp110107","article-title":"Vancomycin dosage in overweight and obese children","volume":"68","author":"Miller","year":"2011","journal-title":"Am J Health Syst Pharm"},{"issue":"3","key":"2021120817332513100_B27","doi-asserted-by":"crossref","first-page":"215","DOI":"10.2165\/00003088-200039030-00004","article-title":"Effects of obesity on pharmacokinetics implications for drug therapy","volume":"39","author":"Cheymol","year":"2000","journal-title":"Clin Pharmacokinet"},{"issue":"5","key":"2021120817332513100_B28","doi-asserted-by":"crossref","first-page":"415","DOI":"10.2165\/00003088-200038050-00003","article-title":"Dosage adjustments for antibacterials in obese patients: applying clinical pharmacokinetics","volume":"38","author":"Bearden","year":"2000","journal-title":"Clin Pharmacokinet"},{"issue":"4","key":"2021120817332513100_B29","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.ijantimicag.2016.01.009","article-title":"Effect of obesity on the pharmacokinetics of antimicrobials in critically ill patients: a structured review","volume":"47","author":"Alobaid","year":"2016","journal-title":"Int J Antimicrob Agents"},{"issue":"1","key":"2021120817332513100_B30","doi-asserted-by":"crossref","first-page":"82","DOI":"10.2146\/ajhp080434","article-title":"Therapeutic monitoring of vancomycin in adult patients: a consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists","volume":"66","author":"Rybak","year":"2009","journal-title":"Am J Health Syst Pharm"},{"issue":"3","key":"2021120817332513100_B31","doi-asserted-by":"crossref","first-page":"e18","DOI":"10.1093\/cid\/ciq146","article-title":"Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children [published correction appears in Clin Infect Dis. 2011;53(3):319]","volume":"52","author":"Liu","year":"2011","journal-title":"Clin Infect Dis"},{"key":"2021120817332513100_B32","unstructured":"Rybak\u2008MJ, Le\u2008J, Lodise\u2008TP, et al. Therapeutic monitoring of vancomycin: a revised consensus guideline and review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society and the Society of Infectious Diseases Pharmacists. 2019. Available at: https:\/\/www.ashp.org\/-\/media\/assets\/policy-guidelines\/docs\/draft-guidelines\/draft-guidelines-ASHP-IDSA-PIDS-SIDP-therapeutic-vancomycin.ashx?la=en. Accessed November 16, 2019"},{"issue":"4","key":"2021120817332513100_B33","doi-asserted-by":"crossref","first-page":"e155","DOI":"10.1097\/INF.0b013e318286378e","article-title":"Improved vancomycin dosing in children using area under the curve exposure","volume":"32","author":"Le","year":"2013","journal-title":"Pediatr Infect Dis J"},{"issue":"4","key":"2021120817332513100_B34","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1097\/FTD.0000000000000039","article-title":"Vancomycin monitoring in children using Bayesian estimation","volume":"36","author":"Le","year":"2014","journal-title":"Ther Drug Monit"},{"issue":"2","key":"2021120817332513100_B35","doi-asserted-by":"crossref","first-page":"e20182179","DOI":"10.1542\/peds.2018-2179","article-title":"Continuous versus intermittent vancomycin infusions in infants: a randomized controlled trial","volume":"143","author":"Gwee","year":"2019","journal-title":"Pediatrics"},{"issue":"7","key":"2021120817332513100_B36","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1097\/INF.0000000000001882","article-title":"Nephrotoxicity with vancomycin in the pediatric population: a systematic review and meta-analysis","volume":"37","author":"Fiorito","year":"2018","journal-title":"Pediatr Infect Dis J"}],"container-title":["Hospital Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/hospitalpediatrics\/article-pdf\/10\/4\/359\/812232\/hpeds_2019-0287.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/hospitalpediatrics\/article-pdf\/10\/4\/359\/812232\/hpeds_2019-0287.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,8]],"date-time":"2021-12-08T18:10:24Z","timestamp":1638987024000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/hospitalpediatrics\/article\/10\/4\/359\/26052\/Vancomycin-Dosing-in-Children-With-Overweight-or"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4,1]]},"references-count":36,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2020,4,1]]},"published-print":{"date-parts":[[2020,4,1]]}},"URL":"https:\/\/doi.org\/10.1542\/hpeds.2019-0287","relation":{},"ISSN":["2154-1663","2154-1671"],"issn-type":[{"value":"2154-1663","type":"print"},{"value":"2154-1671","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,4,1]]}}}