Neonatal vancomycin continuous infusion: still a confusion?

TY - JOUR

T1 - Neonatal vancomycin continuous infusion: still a confusion?

AU - Gwee, Amanda

AU - Cranswick, Noel E

AU - Metz, David

AU - Coghlan, Benjamin

AU - Daley, Andrew J

AU - Bryant, Penelope

AU - Curtis, Nigel

PY - 2014

Y1 - 2014

N2 - BACKGROUND: Continuous infusions of vancomycin over 24 hours have been shown in adults to reduce drug toxicity, lower treatment 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. METHODS: Medline and Embase were searched for studies about continuous vancomycin dosing regimens in neonates that reported serum drug concentrations. The search identified 469 articles, of which 5 were relevant. RESULTS: Five prospective studies were included; 2 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 before continuous infusion; only 1 documented achievement of therapeutic concentrations 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 1 study compared intermittent to continuous infusions, reporting higher attainment of target concentrations with continuous dosing (82 vs. 46 ). No adverse effects were reported, although 3 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.

AB - BACKGROUND: Continuous infusions of vancomycin over 24 hours have been shown in adults to reduce drug toxicity, lower treatment 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. METHODS: Medline and Embase were searched for studies about continuous vancomycin dosing regimens in neonates that reported serum drug concentrations. The search identified 469 articles, of which 5 were relevant. RESULTS: Five prospective studies were included; 2 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 before continuous infusion; only 1 documented achievement of therapeutic concentrations 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 1 study compared intermittent to continuous infusions, reporting higher attainment of target concentrations with continuous dosing (82 vs. 46 ). No adverse effects were reported, although 3 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.

UR - http://www.ncbi.nlm.nih.gov/pubmed/24378952

U2 - 10.1097/INF.0000000000000243

DO - 10.1097/INF.0000000000000243

M3 - Article

VL - 33

SP - 600

EP - 605

JO - Pediatric Infectious Disease Journal

JF - Pediatric Infectious Disease Journal

SN - 0891-3668

IS - 6

ER -