الفهرس 
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Abstract
Objective: to study the significance of monitoring vancomycin levels in pediatric patients treated from different malignancies to decrease nephrotoxicity, adjust dose,to reach rapid response and cost effectiveness.
Patients and Methods: this is a case control study of 150 newly diagnosed pediatric cancer patients, ages 3month to 18year, were treated at the Children’s Cancer Hospital, Egypt (57357-CCHE) between November 2009 and September 2011, from various types of malignancy. They were treated with different nephrotoxic chemotherapies and antibiotics including vancomycin (group I and II). All patients had normal renal functions at the start of the study and were divided into three groups: groupI: 50 patients received vancomycin without monitoring; group II: 50 patients received vancomycin with monitoring; group III served as control and included 50 patients who received vancomycin-free antimicrobial agents. Serum creatinine, vancomycin trough level for group II only, assessment of response, and cost effectiveness were evaluated.
Results: 9 cases (18%) in each of Gr.II and Gr. III developed nephrotoxicity. In Gr.I, 15 cases (30%) developed nephrotoxicity (p= 0.16). The response (period from starting of vancomycin till culture no growth) was different in Gr. II and Gr.I reaching a mean of 6.5 and 8.7 days, respectively (p= 0.015). Rapid response after vancomycin therapy was reached in Gr.II as compared to Gr.I. This led to a shorter hospital stay in the Gr.II with a mean of 10.1 days, while in Gr.I it was 12.4 days (p = 0.003).
Conclusion: Monitoring vancomycin level was cost effective in our high risk groups of pediatric cancer patients treated with different nephrotoxic chemotherapeutic agents and antimicrobials.