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Continuous vancomycin infusions in infants result in earlier, improved target concentrations
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Continuous infusions of vancomycin in infants resulted in optimal concentrations more quickly and at lower total doses compared with intermittent infusions, according to the results of a randomized controlled trial published in Pediatrics.
The researchers wrote that sepsis is a leading cause of death among young infants around the world, and vancomycin is commonly used to treat infants who have suspected or confirmed sepsis, especially in the hospital setting.
“This is an important area to investigate because the WHO has identified optimizing the use of antibiotics as a key strategic objective to tackle the rise in drug-resistant infections,” Amanda Gwee, MBBS, FRACP, DTM&H, a general pediatrician, infectious disease physician and clinical pharmacologist from the Royal Children’s Hospital and senior lecturer in the department of pediatrics at the University of Melbourne told Infectious Diseases in Children. “One of the most common resistant bacteria is methicillin-resistant Staphylococcus aureus, for which vancomycin is the first-line therapy.”
The trial, which was conducted over 40 months, included 111 infants aged 0 to 90 days who were treated in two tertiary neonatal units and required vancomycin for at least 48 hours.
Neonates who received continuous infusions of vancomycin (CIV) were more likely to reach target concentrations compared with those receiving intermittent infusions of vancomycin, or IIV (85% vs. 41%; P = .001). CIV dosing also required less adjustment (median = 0; range = 0-1) compared with IIV (median = 1; range = 0-3).
Gwee and colleagues observed that the average daily dose of vancomycin was smaller when using CIV (40.6 mg per day [standard deviation (SD) = 10.7]) compared with IIV (60.6 mg per day [SD = 53.0]).
“By improving the effectiveness of dosing, we maximize the chance of effective treatment and minimize the risk of emergent resistant bacteria,” Gwee said. “Further studies focused on optimizing dosing and preserving first-line antibiotics in children are needed.” – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.
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