Pediatric pharmaceutical care with anti-infective medication in a patient with acute hematogenous osteomyelitis caused by methicillin-resistant Staphylococcus aureus

• Published in: International journal of immunopathology and pharmacology Vol. 34; p. 2058738420925713
• Main Authors: Lv, Chanmei, Lv, Jiantao, Liu, Yue, Liu, Qifeng, Zou, Dongna
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 2020; Sage Publications Ltd
• Subjects: Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - therapeutic use; Antibiotics; Bacteremia; Bone marrow; C-Reactive Protein - analysis; Case Report; Case reports; Child; Children; Dosage; Drug resistance; Endocarditis; Fasciitis; Female; Humans; Leukocyte Count; Meningitis; Methicillin; Methicillin-Resistant Staphylococcus aureus; Necrotizing fasciitis; Neutrophils; Osteomyelitis; Osteomyelitis - drug therapy; Osteomyelitis - etiology; Osteomyelitis - surgery; Staphylococcal Infections - complications; Staphylococcal Infections - drug therapy; Staphylococcal Infections - surgery; Staphylococcus aureus; Staphylococcus infections; Treatment Outcome; Vancomycin; Vancomycin - administration & dosage; Vancomycin - adverse effects; Vancomycin - therapeutic use; vancomycin serum concentrations; acute hematogenous osteomyelitis (AHO); pharmaceutical care; methicillin-resistant Staphylococcus aureus (MRSA)
• ISSN: 2058-7384; 0394-6320; 2058-7384
• DOI: 10.1177/2058738420925713

The infection of the bone marrow system caused by methicillin-resistant Staphylococcus aureus (MRSA) leads to a variety of common diseases which usually occur in children under the age of 12. Vancomycin (VCM) is the first-line therapy for MRSA-caused serious infections such as bacteremia, infective endocarditis, osteomyelitis, meningitis, pneumonia, and severe skin and soft-tissue infection (e.g. necrotizing fasciitis) with a recommended dosage of 15–20 μg/mL. In this study, we first report a case of a child with MRSA-caused osteomyelitis who was successfully cured by VCM at a concentration of 4.86 μg/mL. VCM’s clinical daily dose of more than 4 g was of concern in light of recent evidence suggesting the increased risks of nephrotoxicity and red man syndrome when Cmin ⩾15 μg/mL and doses ⩾10 mg/kg in children. As far as we know, this is the first report on the lower dose of VCM in children with MRSA osteomyelitis.