Publications & Reports

Neonatal Vancomycin Continuous Infusions: Still a Confusion?

Gwee A, Cranswick N, Metz D, Coghlan B, Daley AJ, Bryant P, Curtis N
1Department of General Medicine, The Royal Children's Hospital Melbourne, Victoria, Australia 2Murdoch Childrens Research Institute, Victoria, Australia 3The University of Melbourne, Victoria, Australia 4Centre for International Health, Burnet Institute,

Abstract

BACKGROUND: Continuous infusions of vancomycin over 24 hours have been shown in adults to reduce drug toxicity, lower costs and require fewer blood samples for therapeutic drug monitoring. They may also improve clinical outcome through earlier attainment of target drug concentrations. In neonates, there is no consensus on vancomycin dosing. We reviewed the literature to assess the evidence for vancomycin dosing regimens for continuous infusion in neonates. METHOD: A single investigator searched Medline and Embase using the OVID interface for studies about continuous vancomycin dosing regimens in neonate that included serum drug concentrations. The search identified 469 articles of which five were relevant. RESULTS: Five prospective studies were included; two studies used non-linear mixed effects modeling. Vancomycin was administered with parenteral nutrition or 5% dextrose. Target serum concentrations varied (range: 10-30 mg/L). Four studies used loading doses prior to continuous infusion; only one documented achievement of therapeutic levels after the load. The time to a therapeutic concentration was not reported for the other studies. Attainment of target concentrations ranged from 56% to 89% of measurements. Only one study compared intermittent to continuous infusions reporting higher attainment of target concentrations with continuous dosing (82% vs 46%). No adverse effects were reported, although three neonates developed a reversible raised serum creatinine in the setting of septicemia. CONCLUSION: Continuous infusions of vancomycin in neonates are well tolerated, require less blood sampling, and may result in improved attainment of target concentrations. Further prospective studies are needed in this population.

Publication

  • Journal: The Pediatric Infectious Disease Journal
  • Published: 01/01/2014
  • Volume: 33
  • Issue: 6
  • Pagination: 600-605

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