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Continuous Versus Intermittent Vancomycin Infusions in Infants: A Randomized Controlled Trial

Amanda Gwee1,2,3, Noel Cranswick4,2,3, Brendan McMullan5,6

  • 1Department of Paediatrics, The University of Melbourne, Parkville, Australia; amanda.gwee@rch.org.au.

Pediatrics
|February 1, 2019
PubMed

Insights

Continuous vancomycin infusions (CIV) in young infants achieve target concentrations faster and require lower doses than intermittent infusions (IIV). Both methods showed no significant drug-related adverse effects, making CIV a potentially more effective option.

Area of Science:

  • Neonatal pharmacology
  • Pediatric infectious diseases
  • Clinical pharmacy

Background:

  • Continuous infusions of vancomycin (CIV) in adults offer advantages in achieving therapeutic drug levels and potentially reducing toxicity.
  • The efficacy and safety of CIV versus intermittent vancomycin infusions (IIV) in young infants remain less understood.
  • Optimizing vancomycin dosing in neonates is critical due to their unique pharmacokinetic profiles.

Purpose of the Study:

  • To compare the effectiveness of continuous vancomycin infusions (CIV) versus intermittent vancomycin infusions (IIV) in young infants.
  • To determine which infusion method achieves target vancomycin concentrations at the first steady-state level more efficiently.
  • To compare the incidence of drug-related adverse effects between CIV and IIV in this population.

Main Methods:

  • A multicenter randomized controlled trial was conducted in two tertiary neonatal units.
  • Young infants (0-90 days) requiring vancomycin therapy for at least 48 hours were randomized to either CIV or IIV.
  • The primary outcome was the proportion of infants achieving target vancomycin concentrations at the first steady-state level.

Main Results:

  • Continuous vancomycin infusions (CIV) resulted in a significantly higher proportion of infants achieving target concentrations (85% vs. 41%, P < .001).
  • Fewer dose adjustments were needed with CIV, and the mean daily dose to reach target levels was lower compared to IIV (40.6 vs. 60.6 mg/kg/day, P = .01).
  • No drug-related adverse effects were observed in either the CIV or IIV groups.

Conclusions:

  • Continuous vancomycin infusions (CIV) are more effective than intermittent vancomycin infusions (IIV) in young infants for achieving target drug concentrations earlier.
  • CIV requires lower total daily doses to reach therapeutic vancomycin levels in neonates.
  • Both CIV and IIV demonstrate comparable safety profiles with no drug-related adverse effects in this study population.
Abstract

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