Vancomycin is a glycopeptide antibiotic that is active against Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus. Nephrotoxicity, which is usually reversible, is the most serious common adverse effect of vancomycin. Vancomycin-associated nephrotoxicity prolongs hospital stays, imposes a need for additional antibiotics and, in rare circumstances, dialysis treatment, and increases medical costs and mortality. Risk factors for nephrotoxicity include the dose and duration of vancomycin treatment, serum trough concentration, patient characteristics, and concomitant receipt of nephrotoxins. Contemporary guidelines recommend targeting vancomycin trough concentrations of ≥10 mg/L to prevent resistance and trough concentrations of 15–20 mg/L to optimize outcomes. There is significant correlation between vancomycin trough serum concentrations and the incidence of vancomycin-associated nephrotoxicity; however, evidence of an association between trough concentrations and efficacy is less convincing. Routine monitoring of serum vancomycin concentrations consumes time and limited healthcare resources and may not be cost effective. The use of alternative antibacterial agents that do not require monitoring would free up pharmacy resources. This time could then be devoted to initiatives such as pharmacist-led antibiotic stewardship programs that are known to reduce antibiotic use and promote improved patient outcomes.

More than 17 million surgical procedures are performed each year in the US.¹ The Centers for Disease Control and Prevention health care–associated infection prevalence survey estimated that there were 110 800 surgical site infections associated with inpatient operations.² Cefazolin, a first-generation cephalosporin, is the guideline-recommended antibiotic for most surgical procedures.^3,4 Cefazolin is the first-line treatment because it is the most widely studied, has the appropriate spectrum of activity against organisms commonly encountered in surgical site infections, is well tolerated, and has a low acquisition cost. However, the 10% of patients reporting a penicillin allergy are less likely to receive cefazolin and more likely to receive clindamycin or vancomycin, resulting in increased odds of developing a surgical site infection.^5,6

Objective: To determine the linear, volumetric, and cross-sectional area measurements in a large sample of subjects seeking treatment in a university clinic of orthodontics. Materials and Methods: Cone-beam computed tomography (CBCT) scans from 387 patients were analyzed retrospectively. All scans were loaded into the 3dMDvultus program (Atlanta, Ga) for airway analysis using automated segmentation. Gender, age, height, weight, airway length, volume, and area of maximum constriction were collected. Results: The rostrocaudal length of the airway increased with age until the age of 15 years in female subjects but continued to increase in male subjects and ranged from 44 to 88 mm over the period of 8 to 18 years of age with the gender data combined. The volume of the airway increased through the entire 11-year age range from 2000 mm ³ to 27,000 mm ³ . The rate of airway volume increased at a slower rate in female than in male subjects. The smallest cross-sectional area increased with age ranging from 20 to 250 mm ² but at a slower rate with female subjects, while male subjects demonstrated a more exponential increase after the age of 13 years. Conclusions: The human airway increases in length and volume during a rapid period of craniofacial growth in patients between the ages of 8 and 18 years, and the site of maximum cross-sectional area constriction can vary.