Comparison of intermittent versus continuous-infusion vancomycin for treating severe patients in intensive care units

Area of Science:

• Pharmacology
• Critical Care Medicine
• Infectious Diseases

Background:

• Vancomycin is a critical antibiotic for treating serious Gram-positive infections.
• Optimizing vancomycin dosing in critically ill patients is essential due to altered pharmacokinetics.
• Intermittent infusion (II) and continuous infusion (CI) are common administration methods with differing pharmacokinetic profiles.

Purpose of the Study:

• To compare the pharmacokinetic characteristics of vancomycin administered via intermittent infusion versus continuous infusion.
• To evaluate the time to reach therapeutic drug levels and steady-state concentrations in critically ill patients.

Main Methods:

• Critically ill patients received vancomycin via either intermittent infusion (30mg/kg loading dose, 15mg/kg q12h) or continuous infusion (30mg/kg loading dose, followed by 30mg/kg/day).
• Blood samples were collected at various time points post-administration for both groups to determine vancomycin serum concentrations.
• Area under the curve (AUC) was calculated to assess overall drug exposure.

Main Results:

• Continuous infusion vancomycin demonstrated higher median serum concentrations at 24 hours (23.59 μg/mL) compared to intermittent infusion at 23 hours (12.30 μg/mL) and 25 hours (17.58 μg/mL).
• Median AUC(24-48h) was significantly higher in the continuous infusion group (530.2 mg.h/L) than in the intermittent infusion group (357.2 mg.h/L).

Conclusions:

• Vancomycin continuous infusion (CI) achieved steady-state concentrations earlier than intermittent infusion (II).
• CI ensures therapeutic vancomycin levels from the first day of treatment, facilitating faster therapeutic drug monitoring.
• Continuous infusion may be a more effective strategy for achieving and maintaining optimal vancomycin exposure in critically ill patients.