{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:11:59Z","timestamp":1753891919388,"version":"3.41.2"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2020,11,30]],"date-time":"2020-11-30T00:00:00Z","timestamp":1606694400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Deviations from the optimal vancomycin dosing may occur in the neonatal and pediatric population due to inconsistencies in the recommended dosing algorithms. This study aims to collect the expert opinions of clinicians who practice in the neonatal or pediatric intensive care units (NICU\/PICUs) of 12 major medical centers in Hong Kong.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> This was a multicenter, cross-sectional study. Eligible physicians and pharmacists completed a structured questionnaire to identify the challenges they encountered when selecting the initial intermittent vancomycin dosing. They also answered questions concerning therapeutic monitoring services (TDM) for vancomycin, including the targeted trough levels for empirical vancomycin regimens administered for complicated and uncomplicated infections.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> A total of 23 physicians and 43 pharmacists completed the survey. The top clinical parameters reported as most important for determining the initial vancomycin dosing were renal function (90.9%), post-menstrual\/postnatal age (81.8%), body weight (66.7%), and suspected\/documented pathogen (53.0%). Respondents reported challenges such as difficulties in determining the optimal initial dose for a targeted level (53.0%), inconsistencies between dosing references (43.9%) and a lack of clear hospital guidelines (27.3%). Half of the pharmacists (48.8%) reported that they had helped to interpret the TDM results and recommend vancomycin dose adjustments in &amp;gt;75% of cases. For methicillin-resistant <jats:italic>Staphylococcus aureus<\/jats:italic> infection, physicians, and pharmacists reported target trough levels of ~10\u201315 and 15\u201320 mg\/L, respectively. For suspected moderate\/uncomplicated Gram-positive infections physicians tended to prefer a lower trough range of 5\u201310 mg\/L, while pharmacists preferred a range of 10\u201315 mg\/L.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> Our results demonstrate that clinicians used varying vancomycin dosing guidelines in their practices. The multidisciplinary TDM service in Hong Kong can be improved further by establishing a standardized dosing guideline and implementing a well-structured, evidence-based service protocol. Future work includes conducting drug utilization studies to evaluate real-world antimicrobial usage patterns and the impact on tangible clinical outcomes, and developing pharmacokinetic-guided dose calculator for antimicrobials in critically ill neonates and pediatric patients.<\/jats:p>","DOI":"10.3389\/fped.2020.538298","type":"journal-article","created":{"date-parts":[[2020,11,30]],"date-time":"2020-11-30T05:18:58Z","timestamp":1606713538000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Vancomycin Prescribing Practices and Therapeutic Drug Monitoring for Critically Ill Neonatal and Pediatric Patients: A Survey of Physicians and Pharmacists in Hong Kong"],"prefix":"10.3389","volume":"8","author":[{"given":"Twinny Cheuk Hin","family":"Chow","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janice Yuen Shun","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jasper Chak Ling","family":"Wong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Freddie Man Hong","family":"Poon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hugh Simon","family":"Lam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teddy Tai-ning","family":"Lam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chui Ping","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Celeste Lom-ying","family":"Ewig","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yin Ting","family":"Cheung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2020,11,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1159\/000226604","article-title":"Long-term trends in the epidemiology of neonatal sepsis and antibiotic susceptibility of causative agents","volume":"97","author":"van den Hoogen","year":"2009","journal-title":"Neonatology"},{"key":"B2","doi-asserted-by":"publisher","first-page":"909","DOI":"10.1111\/ped.12654","article-title":"Neonatal sepsis in a rapidly growing, tertiary neonatal intensive care unit: trends over 18 years","volume":"57","author":"Heo","year":"2015","journal-title":"Pediatr Int"},{"key":"B3","doi-asserted-by":"publisher","first-page":"S2","DOI":"10.1016\/j.jinf.2013.09.011","article-title":"Neonatal sepsis: progress towards improved outcomes","volume":"68","author":"Shane","year":"2013","journal-title":"J Infect"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s40064-015-1146-9","article-title":"Optimization of time to initial vancomycin target trough improves clinical outcomes","volume":"4","author":"Cardile","year":"2015","journal-title":"Springer Plus"},{"key":"B5","doi-asserted-by":"publisher","first-page":"416","DOI":"10.4212\/cjhp.v67i6.1403","article-title":"Achieving therapeutic vancomycin levels in pediatric patients","volume":"67","author":"Hoang","year":"2014","journal-title":"Can J Hosp Pharm"},{"key":"B6","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1186\/1471-2431-14-193","article-title":"Inadequate vancomycin therapy in term and preterm neonates: a retrospective analysis of trough serum concentrations in relation to minimal inhibitory concentrations","volume":"14","author":"Sinkeler","year":"2014","journal-title":"BMC Pediatrics"},{"key":"B7","first-page":"67","article-title":"Evaluation of vancomycin initial dosing and the resultant trough level in paediatric patients","volume":"12","author":"Lim","year":"2014","journal-title":"Malays J Pharm Sci"},{"key":"B8","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1093\/jpids\/pis083","article-title":"Vancomycin dosing practices, trough concentrations, and predicted area under the curve in children with suspected invasive staphylococcal infections","volume":"2","author":"Chhim","year":"2013","journal-title":"J Pediatr Infect Dis Soc"},{"key":"B9","unstructured":"LondonPharmaceutical PressBNF for Children (BNFC) 2016\u201320172016"},{"key":"B10","unstructured":"PattersonC\n            AustralianMH\n          Adelaide, SAAustralian Medicines Handbook Pty. 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