Comparison of Vancomycin Trough Concentrations in Pediatric Patients with and without Sickle Cell Disease: A Cohort Study in Saudi Children.

OBJECTIVE: Sickle cell disease (SCD) is associated with altered renal function, particularly glomerular hyperfiltration, which may increase vancomycin clearance and result in subtherapeutic drug exposure. Limited data exist on vancomycin pharmacokinetics in non-ICU pediatric SCD patients. The objective of this research is to compare vancomycin trough concentrations and dosing requirements between pediatric patients with and without SCD. METHOD: A retrospective cohort study compared two groups-pediatric non-ICU patients with SCD (n=29) and without SCD (n=58)-assessing initial and repeated trough concentrations, dosing regimens, and renal function. The data was collected over 10-year (2014-2024). RESULTS: Among the 87 included patients, 29 were SCD patients and 58 were without SCD Initial serum vancomycin trough concentrations were significantly lower in SCD patients compared to non-SCD patients (5.43 ± 2.61 vs. 10.62 ± 4.71 mg/L; p < 0.00001). Despite dose adjustments, troughs remained lower in SCD patients (10.30 ± 3.61 vs. 13.10 ± 3.73 mg/L; p = 0.0023). SCD patients required higher adjusted doses (64.2 ± 10.0 vs. 58.3 ± 12.0 mg/kg/day). Multiple regression confirmed SCD status as an independent predictor of lower trough concentrations (β = -4.40; p < 0.001). CONCLUSION: Pediatric patients with SCD exhibit significantly lower serum vancomycin trough concentrations and require higher dosing to achieve therapeutic target concentrations. Early therapeutic drug monitoring and individualized dosing strategies are recommended to minimize subtherapeutic exposure and optimize antimicrobial efficacy in this high-risk population.