Évaluation de la pharmacocinétique de la vancomycine chez des enfants atteints de cancer
Bibliographic record
Abstract
Resume Objectif : Comparer une dose de depart de vancomycine de 15 mg/kg/dose a la dose pediatrique usuelle de 10 mg/kg/dose administree toutes les six heures et decrire la pharmacocinetique de la vancomycine chez des enfants atteints de cancer. Methodologie : Il s’agit d’une etude retrospective portant sur des traitements a la vancomycine administres a des enfants atteints de cancer ou ayant recu une greffe de cellules souches hematopoietiques. Nous avons evalue la pharmacocinetique de la vancomycine aux doses usuelles utilisees en pratique et nous avons extrapole l’utilisation d’une dose de depart de 15 mg/kg/dose administree toutes les heures en appliquant des calculs pharmacocinetiques. La nephrotoxicite a ete evaluee en comparant les valeurs de base de creatinine serique aux valeurs finales. Resultats : Nous avons trouve que seuls environ 30 % des patients obtiennent un Cmin et un Cmax therapeutiques avec la dose de 10 mg/kg/dose administree toutes les six heures. Une dose de 15 mg/kg/ dose administree toutes les six heures permet en revanche d’obtenir un Cmin therapeutique dans 42 % des cas et un Cmax therapeutique dans 55 % des cas. Du point de vue de la nephrotoxicite, la creatinine serique de base etait de 41,8 μmol/L alors que la creatinine serique finale etait de 45,4 μmol/L en moyenne. Conclusion : Il semble securitaire d’amorcer le traitement a la vancomycine a une dose de 15 mg/kg/ dose avec une dose maximale de 750 mg pour une atteinte rapide des concentrations seriques therapeutiques et une reduction du nombre de prelevements inutiles. Abstract Objective: To compare a starting dose of vancomycin of 15 mg/kg every 6 hours to the usual pediatric dose of 10 mg/kg every 6 hours. To describe the pharmacokinetics of vancomycin in children with cancer. Methods: This is a retrospective study of vancomycin administered to children with cancer who received a hematopoietic stem cell transplant. We evaluated the pharmacokinetics of vancomycin at the usual doses used in practice and extrapolated the use of a starting dose of 15 mg/kg every 6 hours through pharmacokinetics calculations. Nephrotoxicity was evaluated by comparing baseline serum creatinine values to their final values. Results: We observed that only 30% of patients obtained therapeutic Cmin and Cmax values with 10 mg/kg dosed every 6 hours. With a dose of 15 mg/kg given every 6 hours, a therapeutic Cmin was achieved in 42% of cases and a therapeutic Cmax in 55% of cases. From a nephrotoxicity point of view, average baseline serum creatinine was 41.8 μmol/L while the final average serum creatinine value was 45.4 μmol/L. Conclusion: It seems safe to initiate vancomycin at a dose of 15 mg/kg, with a maximum dose of 750 mg, in order to obtain therapeutic serum concentrations more rapidly and to limit unnecessary sampling. Key words: vancomycin, pharmacokinetics, dose, dosage, serum concentrations, pediatrics, children, oncology, cancer.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".