Continuous-infusion vancomycin therapy for preterm neonates with suspected or documented Gram-positive infections: a...

Intermittent infusion of vancomycin is widely used to treat late-onset sepsis in neonates. On the other hand, the continuous infusion of vancomycin could improve bactericidal efficacy since its action is time dependent.

To evaluate a simplified dosage schedule for continuous-infusion vancomycin therapy.

Prospective study in premature neonates (<34 weeks) with suspected coagulase-negative staphylococci (CoNS) sepsis. Before antibiotics at time zero (T0), serum creatinine was measured and blood cultures were collected. Vancomycin dosage began with 25 mg/kg/day or 15 mg/kg/day (period 1) and 30 mg/kg/day or 20 mg/kg/day (period 2) depending on whether serum creatinine was below or above 90 mumol/l. Two days after beginning treatment (first timepoint: T1), serum vancomycin was measured and second blood cultures were collected.

Between June 2002 and December 2005, 145 neonates were evaluated. At birth, the median (interquartile range) body weight was 920 (500-1160) g and gestational age was 28 (26-29) weeks. At T1, serum vancomycin was within the required range in 74.5% of neonates (108/145). Serum vancomycin levels were higher in period 2 than in period 1 (20 mg/l vs 13 mg/l, p<0.05). At T0, 55% (80/145) of blood cultures were positive for CoNS, but 71% (57/80) were negative at T1. Four days after beginning treatment, 92% of subjects had recovered without removing the central venous catheter.

Using this simplified dosage schedule, bactericidal efficacy was maintained and most subjects had serum vancomycin concentrations within the therapeutic range.