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continuous versus intermittent infusion of vancomycin

Amanda Gwee, Noel Cranswick, Brendan McMullan, Elizabeth Perkins, Srinivas Bolisetty, Kaya Gardiner, Andrew Daley, Meredith Ward, Roberto Chiletti, Susan Donath, Rodney Hunt, Nigel Curtis
BACKGROUND: In adults, continuous infusions of vancomycin (CIV) are associated with earlier attainment of target drug concentrations, require fewer blood samples for monitoring, and may reduce drug toxicity. We aimed to determine, in young infants, if CIV or intermittent infusions of vancomycin (IIV) better achieves target vancomycin concentrations at the first steady-state level and to compare the frequency of drug-related adverse effects. METHODS: In a multicenter randomized controlled trial in 2 tertiary neonatal units over a 40-month period, young infants aged 0 to 90 days requiring vancomycin therapy for at least 48 hours were randomly assigned to CIV and IIV...
January 30, 2019: Pediatrics
Amanda L Hurst, Christine Baumgartner, Christine E MacBrayne, Jason Child
Background: There is a paucity of data on dosing of continuous infusion of vancomycin (CIV) in pediatric patients, despite it being an attractive treatment option for limiting escalating doses of intermittent infusion of vancomycin. The purpose of this study was to determine the total daily dose of CIV required to attain therapeutic serum vancomycin concentrations (SVCs) in pediatric patients according to age (≥31 days to <2 years, 2 to <8 years, and 8 to <18 years). Methods: We retrospectively evaluated patients who were transitioned from intermittent infusion of vancomycin to CIV between January 2013 and December 2016...
April 30, 2018: Journal of the Pediatric Infectious Diseases Society
Fawzy Elbarbry
After more than six decades of its use as the mainstay antibiotic for the treatment of multidrug-resistant Gram-positive bacterial infections, dosing and monitoring of vancomycin therapy have not been optimized. The current vancomycin therapeutic guidelines recommend empiric doses of 15-20 mg/kg administered by intermittent infusion every 8-12 h in patients with normal kidney function. Additionally, the guidelines recommend trough concentration of 15-20 mg/L as a therapeutic goal for adult patients with severe infections...
June 2018: European Journal of Drug Metabolism and Pharmacokinetics
Jonathan H Sin, Kelly Newman, Ramy H Elshaboury, D Dante Yeh, Marc A de Moya, Hsin Lin
Objectives: The most optimal method of attaining therapeutic vancomycin concentrations during continuous venovenous haemofiltration (CVVH) remains unclear. Studies have shown continuous infusion vancomycin (CIV) achieves target concentrations more rapidly and consistently when compared with intermittent infusion. Positive correlations between CVVH intensity and vancomycin clearance (CLvanc) have been noted. This study is the first to evaluate a CIV regimen in patients undergoing CVVH that incorporates weight-based CVVH intensity (mL/kg/h) into the dosing nomogram...
January 1, 2018: Journal of Antimicrobial Chemotherapy
Erik M van Maarseveen, Suzan Gipmans, Erwin Vasbinder, Manfred Petjak, Arthur R H van Zanten
BACKGROUND: To increase target attainment rates, switching the mode of administration from intermittent (InI) to continuous infusion (CoI) has been proposed. In this study, target attainment rates and interpatient variation in exposure were compared between vancomycin InI- and CoI-treated critically ill patients. METHODS: An observational cohort study was conducted among critically ill patients admitted to a level-2 intensive care unit. Adult patients (18 years or older) treated with intravenous vancomycin for various indications, including sepsis, pneumonia, and endocarditis between 2007 and 2013 were eligible for inclusion...
June 2016: Therapeutic Drug Monitoring
Jing-Jing Hao, Han Chen, Jian-Xin Zhou
Continuous infusion of vancomycin (CIV) and intermittent infusion of vancomycin (IIV) are two major administration strategies in clinical settings. However, previous articles comparing the efficacy and safety of CIV versus IIV showed inconsistent results. Therefore, a meta-analysis was conducted to compare the efficacy and safety of CIV and IIV. PubMed, the Cochrane Library and Web of Science up to June 2015 were searched using the keywords 'vancomycin', 'intravenous', 'parenteral', 'continuous', 'intermittent', 'discontinuous', 'infusion', 'administration' and 'dosing'...
January 2016: International Journal of Antimicrobial Agents
B Demirel, E İmamoglu, T Gursoy, U Demirel, S Topçuoglu, G Karatekin, F Ovali
BACKGROUND: Vancomycin a frequently used antimicrobial for the treatment of late-onset neonatal sepsis. It can be infused either intermittently or continuously, however, there is no consensus on the optimal dosing regimen. AIM: To evaluate microbiological outcomes, clinical response and adverse events of vancomycin when administered via continuos intravenous infusion. METHODS: The files of preterm infants (<34 weeks), who received either intermittent (group I, n = 41) or continuous (group II, n = 36) vancomycin infusion for the treatment of late-onset sepsis, were investigated retrospectively...
2015: Journal of Neonatal-perinatal Medicine
Timothy Hanrahan, Tony Whitehouse, Jeffrey Lipman, Jason A Roberts
Vancomycin is a glycopeptide antibiotic widely used in the management of meticillin-resistant Staphylococcus aureus (MRSA). Guidelines currently recommend vancomycin be administered by intermittent infusion, despite recent research suggesting that continuous infusion (CI) may be associated with lower rates of vancomycin-associated nephrotoxicity. In 2012, Cataldo et al. presented a meta-analysis supporting the use of CI. Here we present an updated meta-analysis, inclusive of a recently published large-scale retrospective study...
September 2015: International Journal of Antimicrobial Agents
Hsin Lin, Yana Bukovskaya, Marc De Moya, Jarone Lee, Ulrich Schmidt
BACKGROUND: Vancomycin during continuous venovenous hemofiltration (CVVH) is either administered by intermittent infusion (II) or continuous infusion (CI). In this patient population, the best method to rapidly achieve target serum concentrations of 15 mcg/ml to 25 mcg/ml remains to be elucidated. We hypothesized that CI would achieve a target serum level of 15 mcg/ml to 25 mcg/ml within 24 h of the initiation of therapy more consistently than II. METHODS: A retrospective cohort study of adult patients admitted to the intensive care unit (ICU) between 2011 and 2014 receiving intravenous vancomycin with 24-hour serum level while on CVVH was included...
2015: Annals of Intensive Care
S Tafelski, I Nachtigall, Uwe Troeger, Maria Deja, Alexander Krannich, Karsten Günzel, C Spies
Different dosing regimens for vancomycin are in clinical use: intermittent infusion and continuous administration. The intention of using these different dosing regimens is to reduce toxicity, to achieve target levels faster and to avoid treatment failure. The aim of this phase IV study was to compare safety and effectiveness in both administration regimens. The study was conducted in 2010 and 2011 in three postoperative intensive care units (ICUs) in a tertiary care university hospital in Berlin, Germany. Adult patients with vancomycin therapy and therapeutic drug monitoring were included...
July 2015: Journal of Infection and Public Health
Stijn Blot, Despoina Koulenti, Murat Akova, Matteo Bassetti, Jan J De Waele, George Dimopoulos, Kirsi-Maija Kaukonen, Claude Martin, Philippe Montravers, Jordi Rello, Andrew Rhodes, Therese Starr, Steven C Wallis, Jeffrey Lipman, Jason A Roberts
INTRODUCTION: The objective of this study was to describe the pharmacokinetics of vancomycin in ICU patients and to examine whether contemporary antibiotic dosing results in concentrations that have been associated with favourable response. METHODS: The Defining Antibiotic Levels in Intensive Care (DALI) study was a prospective, multicentre pharmacokinetic point-prevalence study. Antibiotic dosing was as per the treating clinician either by intermittent bolus or continuous infusion...
May 15, 2014: Critical Care: the Official Journal of the Critical Care Forum
Thomas M Schmelzer, A Britton Christmas, H James Norton, B Todd Heniford, Ronald F Sing
Current guidelines for the empiric treatment of ventilator-associated pneumonia (VAP) recommend that vancomycin is dosed 15 mg/kg and administered twice daily for a target trough level of 15 to 20 μg/mL. This study compared conventional intermittent vancomycin infusion (IVI) with continuous vancomycin infusion (CVI). Our prospective, randomized study compared CVI with IVI in trauma patients with suspected VAP. The primary outcome measure was a serum vancomycin level within the target level 48 hours after initiation of therapy...
November 2013: American Surgeon
Sally S K Man, Roxane R Carr, Mary H H Ensom
BACKGROUND: There is some evidence that administration of vancomycin by continuous infusion has pharmacokinetic and pharmacodynamic advantages over traditional intermittent dosing. Whether these advantages translate into clinical efficacy remains controversial. OBJECTIVE: To review the literature comparing continuous infusion of vancomycin and conventional intermittent IV dosing in terms of efficacy and safety. METHODS: A literature search was conducted in the PubMed/MEDLINE and Embase databases and the Cochrane Central Register of Controlled Trials, and by means of the Google search engine, and the reference lists of pertinent articles were searched manually...
September 2010: Canadian Journal of Hospital Pharmacy
Maria Adriana Cataldo, Evelina Tacconelli, Elisabetta Grilli, Federico Pea, Nicola Petrosillo
OBJECTIVES: To summarize available evidence on the effect of continuous infusion (CoI) of vancomycin compared with intermittent infusion (InI) in adult patients with Gram-positive infections. METHODS: MEDLINE, EMBASE and Cochrane databases were searched. Randomized clinical trials (RCTs) and observational studies that comparatively assessed CoI and InI of vancomycin in terms of mortality, clinical cure, toxicity rates and serum drug exposure [trough concentration (C(min)) for InI and steady-state concentration (C(ss)) for CoI; area under the curve at 24 h (AUC(24)) for both] were included...
January 2012: Journal of Antimicrobial Chemotherapy
Winfried V Kern
PURPOSE OF REVIEW: Staphylococcus aureus is among the leading causes of community-acquired as well as healthcare-associated and hospital-acquired bacteremia and endocarditis. The purpose of this review was to analyze most recent data relevant to the clinical management of S. aureus bacteremia (SAB) and endocarditis. RECENT FINDINGS: Population-based studies have shown that the incidence of SAB has not decreased in the last years and that healthcare-associated and nosocomial cases continue to account for at least half of SAB...
August 2010: Current Opinion in Infectious Diseases
Sutep Jaruratanasirikul, Jakrawadee Julamanee, Teeratad Sudsai, Phanvasri Saengsuwan, Monchana Jullangkoon, Natnicha Ingviya, Roongrueng Jarumanokul
OBJECTIVE: To compare the pharmacokinetics of vancomycin administration by continuous infusion and intermittent infusion. MATERIAL AND METHOD: A prospective, randomized, two-way crossover study of 12 patients with methicillin-resistant Staphylococcus aureus infections was conducted. All patients were randomized to receive vancomycin in both regimens consecutively: (i) infusion of 15 mg/kg of vancomycin as a loading dose for 1 h followed by 30 mg/kg of vancomycin as a continuous infusion over 24 h for 48 h; and (ii) intermittent infusion of 15 mg/kg of vancomycin for 1 h every 12 h for 48 h...
February 2010: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
Paul R Ingram, David C Lye, Dale A Fisher, Wei-Ping Goh, Vincent H Tam
Intravenous (i.v.) vancomycin is increasingly used as outpatient parenteral antimicrobial therapy (OPAT). Despite the potential advantages of administration by continuous infusion (CI) compared with intermittent infusion (II), the relative nephrotoxicity of these two modes of delivery has not been well established. We compared the rate of nephrotoxicity of vancomycin given by CI and II. A retrospective cohort study of OPAT patients receiving i.v. vancomycin between January 2004 to June 2008 was performed. All patients had a normal baseline serum creatinine concentration...
December 2009: International Journal of Antimicrobial Agents
Doris Hutschala, Christian Kinstner, Keso Skhirdladze, Florian Thalhammer, Markus Müller, Edda Tschernko
BACKGROUND: Vancomycin is frequently used in clinical practice to treat severe wound and systemic infections caused by Gram-positive bacteria after cardiac surgery. The drug is excreted almost entirely by glomerular filtration and might exhibit nephrotoxic side effects. This study compared the nephrotoxic impact of vancomycin during continuous versus intermittent administration. METHODS: The authors analyzed 149 patients admitted to the intensive care unit during a 5-yr period...
August 2009: Anesthesiology
Sofia K Kasiakou, George J Sermaides, Argyris Michalopoulos, Elpidoforos S Soteriades, Matthew E Falagas
Intermittent intravenous administration of antibiotics is the first-line approach in the management of severe infections worldwide. However, the potential benefits of alternate modes of administration of antibiotics, including continuous intravenous infusion, deserve further evaluation. We did a meta-analysis of randomised controlled trials comparing continuous intravenous infusion with intermittent intravenous administration of the same antibiotic regimen. Nine randomised controlled trials studying beta-lactams, aminoglycosides, and vancomycin were included...
September 2005: Lancet Infectious Diseases
Emmanuelle Boffi El Amari, Albert Vuagnat, Richard Stern, Mathieu Assal, Philippe Denormandie, Pierre Hoffmeyer, Louis Bernard
It is important to identify the optimal dosage and best method of infusion of parenteral vancomycin to be used over a several week period for the treatment of osteomyelitis. A retrospective study was undertaken to compare a high dose vancomycin treatment (HD: 40 mg/kg/d) with a standard dose treatment (SD: 20 mg/kg/d), and also to compare the modality of infusion using either intermittent vancomycin infusion (IVI) or continuous vancomycin infusion (CVI). 89 patients with Gram-positive cocci osteomyelitis requiring vancomycin treatment were followed, and the outcome and therapeutic safety were compared...
2004: Scandinavian Journal of Infectious Diseases
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