Continuous Infusion Of Vancomycin Research Articles

Unbound fraction of vancomycin in intensive care unit patients

Published data on the unbound fraction of vancomycin in patient samples exhibit high variability. In the present study, a robust ultrafiltration method was developed and applied to 102 clinical samples from 22 intensive care unit patients who were treated with continuous infusion of vancomycin. A validated HPLC method was used for determination of total and unbound concentrations. The mean unbound fraction was 67.2% (standard deviation 7.5%, range 47.2-92.1%) and independent of total concentration of vancomycin or of albumin. The unbound fraction was significantly correlated (r = +0.67, P = .0009) with the renally filtered fraction (drug clearance/creatinine clearance), providing functional evidence for the validity of the measurements. Ultrafiltration proved to be susceptible to variations in the experimental conditions such as pH, temperature and centrifugal force. The measured unbound fraction increased from 60% at pH 6 to 100% at pH 9, from 57% at 4°C to 80% at 37°C, and was 76% at 1,000 g compared with 45% at 10,000 g. Lack of standardization may therefore partly explain the variable results reported in the literature.

Neutropenia is rare in patients receiving continuous infusions of vancomycin in an Australian Hospital in the Home setting

Neutropenia is rare in patients receiving continuous infusions of vancomycin in an <scp>A</scp>ustralian <scp>H</scp>ospital in the <scp>H</scp>ome setting

A new regimen for continuous infusion of vancomycin during continuous renal replacement therapy

Continuous infusion (CI) of high-dose vancomycin is often used to treat life-threatening infections caused by less-susceptible Gram-positive bacteria. However, this approach has not been well studied in patients on continuous renal replacement therapy (CRRT). The aim of this study was to evaluate the adequacy of a new CI vancomycin regimen in septic patients undergoing CRRT. In this prospective study we measured vancomycin concentrations obtained with a new CI regimen for CRRT, which included a loading dose of 35 mg/kg given over a 4 h period followed by a daily dose of 14 mg/kg. Vancomycin concentrations were measured: at the end of the loading dose (T1); 12 h after the onset of therapy (T2); and 24 h after the onset of therapy (T3). Drug concentrations (at T2 and T3) were considered adequate if between 20 and 30 mg/L. CRRT intensity was calculated as: dialysate rate (mL/kg/h) + ultrafiltration rate (mL/kg/h). Vancomycin population pharmacokinetics were calculated using non-linear mixed-effects modelling. We studied 32 patients who received median (IQR) loading and daily vancomycin doses of 2750 mg (2250-3150) and 1100 mg (975-1270), respectively. Drug concentrations were: T1, 44 mg/L (38-58); T2, 27 mg/L (24-31); and T3, 23 mg/L (19-31). Vancomycin concentrations were adequate in 22/32 patients (69%) at T2 and in 20/32 (63%) at T3. The two relevant covariates that significantly affected drug concentrations were body weight and CRRT intensity. This new vancomycin regimen allowed the rapid achievement of target drug concentrations in the majority of patients. CRRT intensity had an influence on vancomycin clearance.

Development of acute kidney injury during continuous infusion of vancomycin in septic patients

Few data are available on the occurrence of renal failure during continuous infusion of vancomycin in critically ill patients. We reviewed the data of all patients admitted to the intensive care unit (ICU) between January 2008 and December 2009 in whom vancomycin was given as a continuous infusion for more than 48 h in the absence of renal replacement therapy. We collected data on the doses of vancomycin and blood concentrations during therapy. Acute kidney injury (AKI) was defined as a daily urine output <0.5 ml/kg/h and/or an increase in the serum creatinine of ≥0.3 mg/dl from baseline levels during vancomycin therapy or within 72 h after its discontinuation. Multivariable logistic regression analysis was performed to identify predictors of AKI. Of 207 patients who met the inclusion criteria, 50 (24 %) developed AKI. These patients were more severely ill, had lower creatinine clearance at admission, were more frequently exposed to other nephrotoxic agents, had a longer duration of therapy, and had higher concentrations of vancomycin during the first 3 days of treatment (C(mean)). The C(mean) was independently associated with early AKI (within 48 h from the onset of therapy) and the duration of vancomycin administration with late AKI. AKI occurred in almost 25 % of critically ill patients treated with a continuous infusion of vancomycin. Vancomycin concentrations and duration of therapy were the strongest variables associated with the development of early and late AKI during therapy, respectively.

Vancomicina en infusión continua en pacientes pediátricos críticos

Continuous infusion of vancomycin may be a strategy for critically ill patients who do not achieve adequate plasma levels. There is few literature on this dosage regimen. We present six children (2 months to 7 years, 4 male and 2 female), admitted to the Intensive Care Unit of the "Prof. Dr. Garrahan Children Hospital", with methicillin-resistant Staphylococcus aureus sepsis, treated with vancomycin 40 and 60 mg/kg/day every 8-6 hrs. Continuous infusion at 50 mg/kg/day was implemented due to poor outcome, persistent fever, positive cultures and inadequate vancomycin plasma levels. All patients achieved levels between 10 and 25 ug/ml, their outcome was favorable and cultures became negative, with no signs of nephrotoxicity. Treatment duration of the continuous infusion was 9 to 18 days. Continuous infusion of vancomycin was effective in these patients without evidence of associated nephrotoxicity.

Review of Continuous-Infusion Vancomycin

To evaluate the efficacy and safety of administering vancomycin as a continuous infusion. Literature was accessed through MEDLINE (1977-September 2012), Embase (1977-September 2012), and Google Scholar, using the terms vancomycin, continuous, discontinuous, infusion, pharmacokinetics, pharmacodynamics, and nephrotoxicity. In addition, reference citations from publications identified were reviewed. All English-language articles identified from the data sources were evaluated. Studies including more than 30 adults were included in the safety and efficacy review. Infections due to methicillin-resistant Staphylococcus aureus (MRSA) carry a significant risk of morbidity and mortality. Vancomycin is commonly prescribed for invasive MRSA infections and has been traditionally administered as an intermittent infusion. Administering vancomycin as a continuous infusion is a novel approach to improving its efficacy and safety profile. Fourteen clinical trials were reviewed (2 prospective, 1 meta-analysis, 11 retrospective). The pharmacodynamic profiles between continuous-infusion vancomycin and intermittent-infusion vancomycin were comparable. Continuous-infusion therapy did not significantly improve the efficacy of vancomycin in the treatment of invasive MRSA infections. Conflicting results exist regarding the safety profile of continuous-infusion compared with intermittent-infusion vancomycin. The only published prospective randomized clinical trial comparing continuous infusion with intermittent therapy found no significant difference in the rates of nephrotoxicity. The data from retrospective studies are heterogeneous and show variable rates of nephrotoxicity. In general, compatibility information for administering vancomycin as a continuous infusion is unavailable. Overall, currently available evidence is insufficient to conclude whether an improvement in vancomycin efficacy exists when it is administered as a continuous infusion. The risk of nephrotoxicity associated with continuous-infusion vancomycin requires further investigation in prospective randomized trials. Specific patient populations that would benefit from continuous-infusion vancomycin have yet to be determined.

Continuous high-dose vancomycin combination therapy for methicillin-resistant staphylococcal prosthetic hip infection: a prospective cohort study

Few data are available on treatment and outcome of methicillin-resistant (MR) staphylococcal prosthetic joint infections. Vancomycin remains the treatment of choice for these infections, but its efficacy and safety in bone-and-joint infections are insufficiently documented. We conducted a prospective cohort study on 60 patients treated between November 2002 and December 2008 for chronic MR staphylococcal (44 S. epidermidis, nine other coagulase-negative Staphylococcus and seven S. aureus) prosthetic hip infections (PHIs). Twentytwo patients had previously undergone surgery for their PHI and 21 had previously received antibiotics. All patients had surgery (exchange arthroplasty for 58 patients, resection arthroplasty for two) and received an antibiotic regimen combining high-dose continuous intravenous vancomycin infusion (target serum concentration 30–40 mg/L) with another antibiotic for 6 weeks, followed by an additional 6 weeks of oral intake. Two years after surgery, infection was considered cured in 41 (68%) patients and only two relapses occurred after one-stage exchange arthroplasty. Nineteen (32%) patients experienced nephrotoxicity that was generally mild (RIFLE class R for 14 patients, class I for four patients and class F for one patient) and most often reversible. Continuous high-dose intravenous vancomycin combination therapy is an effective, feasible and reasonably safe treatment of chronic MR staphylococcal PHI.

Continuous infusion of vancomycin in septic patients receiving continuous renal replacement therapy

Vancomycin is frequently administered as a continuous infusion to treat severe infections caused by Gram-positive bacteria. Previous studies have suggested a loading dose of 15mg/kg followed by continuous infusion of 30mg/kg in patients with normal renal function; however, there are no dosing recommendations in patients with renal failure undergoing continuous renal replacement therapy (CRRT). Data from all adult septic patients admitted to a Department of Intensive Care over a 3-year period in whom vancomycin was given as a continuous infusion were reviewed. Patients were included if they received vancomycin for ≥48h during CRRT. Vancomycin levels were obtained daily. During the study period, 85 patients (56 male; mean age 65±15 years; weight 85±24kg) met the inclusion criteria. Median (interquartile range) APACHE II and SOFA scores were 24 (20–29) and 11 (7–14), respectively, and the overall mortality rate was 59%. Mean vancomycin doses were 16.4±6.4 (loading dose), 23.5±8.1 (Day 1), 23.2±7.4 (Day 2) and 23.3±11.0 (Day 3)mg/kg, resulting in blood concentrations of 24.7±9.0 (Day 1), 26.0±8.1 (Day 2) and 27.7±9.3 (Day 3)μg/mL. On Day 1, 43 patients (51%) had adequate drug concentrations (20–30μg/mL), 17 (20%) had levels >30μg/mL and 25 (29%) had levels <20μg/mL. Most patients with adequate drug concentrations received a daily dose of 16–35mg/kg. The intensity of CRRT directly influenced vancomycin concentrations on Day 1 of therapy.

A specially tailored vancomycin continuous infusion regimen for renally impaired critically ill patients.

Background:Vancomycin remains the gold standard for treatment of methicillin-resistant Staphylococcus aureus. Specially designed continuous infusion of vancomycin leads to better therapy.Methodology:A total of 40 critically ill patients who suffered from pneumonia susceptible to vancomycin, had serum creatinine >1.4 mg%, and oliguria <0.5 mL/kg/h for 6 h were included in the study with respiratory culture sensitivity to vancomycin ≤2 mg/L. Patients’ clinical, microbiological, and biological data were obtained by retrospective analysis of the corresponding medical files before and after vancomycin treatment. Patients with serum creatinine level ≥4 mg% and patients who received renal replacement therapy during the treatment period were excluded. The patients were divided into two groups—group 1 (intermittent dosing) and group 2 (continuous infusion) based on the following formula: rate of vancomycin continuous infusion (g/day) = [0.0205 creatinine clearance (mL/min) + 3.47] × [target vancomycin concentration at steady state (µg/mL)] × (24/1000). Trough vancomycin serum levels were also assessed using high-performance liquid chromatographic technique. Patients’ outcomes such as clinical improvement, adverse events, and 15-day mortality were reported.Results:Group 2 showed significant reduction in blood urea nitrogen, creatinine serum levels, white blood cells, partial carbon dioxide pressure, body temperature, and Sequential Organ Failure Assessment score, while significant increase in partial oxygen pressure and saturated oxygen was also observed. A significantly shorter duration of treatment with a comparable vancomycin serum levels was also reported with group 2.Conclusion:After treatment, comparison in patients’ criteria supports the superiority of using continuous infusion of vancomycin according to this equation in renally impaired patients.

Vancomycin continuous infusion in neonates: dosing optimisation and therapeutic drug monitoring

ObjectiveBecause pharmacokinetic data are limited, continuous infusions of vancomycin in neonates are administered using different dosing regimens. The aim of this work was to evaluate the results of vancomycin therapeutic...

Evaluation of a pediatric continuous-infusion vancomycin therapy guideline

An institutional guideline for converting pediatric patients to continuous-infusion vancomycin (CIV) therapy if therapeutic targets are not achieved with intermittent i.v. dosing was evaluated. All patients within a specified age range (>6 months but <19 years) who were converted to CIV therapy for pneumonia or osteomyelitis during the 2 years after guideline implementation were included in the evaluation. The guideline calls for conversion to CIV therapy if goals for trough serum vancomycin concentration (SVC) are not attained with escalating intermittent-infusion vancomycin (IIV) dosing. Primary outcome measures included the rate of attainment of the goal steady-state trough SVC (15-20 mg/L), preferably within 24-48 hours, the adequacy of an empirical dosing strategy, and adverse events. Secondary study outcomes included final vancomycin doses and the time to attainment of therapeutic SVCs. Within 24-48 hours after conversion to CIV therapy, the mean initial plateau SVC in the evaluated cases (n = 15) was 20.2 mg/L; the mean of all SVCs was 19.1 mg/L. The range of dosages required to achieve a plateau SVC of 15 mg/L was 23.8-65.4 mg/kg/day (median, 41 mg/kg/day). The mean ± S.D. vancomycin dosage at the end of CIV therapy was 44.3 ± 12.8 mg/kg/day. Monitoring of serum creatinine, urine output, and glomerular filtration rate indicated that no patients developed nephrotoxicity during CIV therapy. Conversion from IIV to CIV therapy in selected pediatric patients appeared to be safe and well tolerated, with few adverse effects noted. Using the institutional CIV dosing guideline, goal plateau SVC values were attained in most patients within 24-48 hours.

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Introduction: Antibiotics are often administered in patients treated by extracorporeal membrane oxygenation (ECMO) but pharmacokinetics (PKs) of antibiotics during ECMO have not been well defined.Hypothesis: To evaluate vancomycin concentrations in critically ill patients treated with ECMO.Methods: We reviewed all patients who received a continuous infusion (CI) of vancomycin when on ECMO support from January 2011 to May 2012. Vancomycin was given as a 35 mg/kg loading dose in 4-hr, and the infusion doses were adapted to creatinine clearance, CrCL). Drug concentrations were measured at 4 (T1), 12 (T2) and in the first 24 hours (T3) after the onset of therapy. Using a database reporting all patients having this vancomycin regimen, ECMO patients were matched (1:1) with non-ECMO patients according to four criteria: 1) renal function (i.e. same CrCL or both on continuous renal replacement therapy, CRRT); 2) total body weight; 3) Sequential Organ Failure Assessment (SOFA) score; 4) age. Vancomycin concentrations between 20 and 30 [micro]g/ml were considered as adequate.Results: We compared 11 patients treated with ECMO and 11 well matched controls. Mean vancomycin loading (2500 [1610-2975] mg vs. 2450 [1645-3500] mg) and daily doses (1125 [750-3000] vs. 1200 [750-2500] mg) were similar in the two groups. Drug concentrations in ECMO and non-ECMO patients were: 51 [28-71] mcg/mL vs. 45 [37-71] mcg/mL on T1; 23 [16-38] vs. 29 [21-35] mcg/mL on T2; 20 [12-36] vs. 23 [17-28] mcg/mL on T3 (ANOVA, p=0.53). The number of patients with insufficient drug concentrations in ECMO group was 2 on T2 and 4 on T3 when compared to 0 and 1, respectively, in the control group.Conclusions: Vancomycin concentrations in the early phase of therapy were quite similar in patients treated or not with ECMO. Nevertheless, more patients in the ECMO group tended to have insufficient drug concentrations, so that vancomycin doses should be probably increased somewhay in these patients.

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Introduction: Despite the development of new molecules with anti-Gram positive bacteria activity, vancomycin is still the treatment of choice in septic critically ill patients. Because sepsis can alter drug pharmacokinetics, the development of an administration strategy able to promptly provide adequate antimicrobial concentrations is crucial.Hypothesis: The aim of this study was to prospectively validate a new regimen of vancomycin given by continuous infusion (CI)1 in septic patients.Methods: We prospectively included septic patients admitted to a mixed ICU from January 2011 to May 2012, treated with a new regimen of CI vancomycin, including a loading dose (LD) of 35 mg/kg of body weight given as a 4-hr infusion, followed by a daily CI dose adapted on creatinine clearance (CrCL), estimated by the Cockroft-Gault formula. We excluded patients treated by extracorporeal replacement therapies or less than 18 years of age. Serum vancomycin levels were measured at the end of LD, 12, 24 (n=107) and 48 hours (n=56) after the start of therapy. Dose adjustment was decided on drug concentrations at 24 and/or 48 hours. Adequate vancomycin concentrations were considered between 20 and 30 [micro]g/ml.Results: A total of 107 patients were included (77 male, age: 59 [48-71] years; weight: 75 [65-85] kgs; medical admission 69 (64%). Median APACHE II score on admission was 19 [14-23]. Mechanical ventilation was used in 58 (54%) patients and septic shock was present in 54 (53%). Overall ICU mortality was 22%. Median loading and daily doses were 2650 [2288 +/- 2295] mg and 2112 [1500-2838] mg/day, respectively. Vancomycin concentrations were 44 [37-49] [micro]g/mL at the end of LD and then 25 [21-32], 22 [19-28] and 26 [22-29] [micro]g/mL at 12, 24 and 48 hrs, respectively. Insufficient drug concentrations were found in 17 (16%), 29 (27%) and 4 (7%) patients at 12, 24 and 48 hrs, respectively and excessive levels (>30[micro]g/mL) were found in 30 (28%), 19 (17%) and 5 (9%).Conclusions: Higher than recommended regimen of vancomycin is needed to avoid insufficient drug concentrations levels in septic patients within the first 48 hours of therapy.

Continuous Infusion Vancomycin for Treatment of Methicillin-Resistant Staphylococcus aureus in Cystic Fibrosis Patients

To report 3 cases of methicillin-resistant Staphylococcus aureus (MRSA) in pediatric patients with cystic fibrosis (CF), all of whom had inadequate serum concentrations of vancomycin with conventional intermittent dosing and who achieved therapeutic serum concentrations with continuous infusions of vancomycin. In the first case, a 3-year-old patient failed to achieve therapeutic vancomycin trough concentrations despite 2 dose adjustments up to 19 mg/kg every 6 hours. A continuous infusion was initiated and a therapeutic steady-state level was obtained. The remaining case reports describe 2 patients who were readmitted to the hospital after having received intermittent dosing as outpatients. Continuous infusions were started upon readmission, and therapeutic serum concentrations were achieved in both patients. MRSA is a common pathogen in patients with CF. Intravenous vancomycin, a time-dependent antibiotic that is extensively eliminated by the kidneys, is frequently used to treat MRSA infections. Serum trough concentrations of 15-20 mg/L are considered therapeutic, but these levels are difficult to achieve in patients with CF because of increased renal clearance. Continuous infusions of vancomycin were successfully used in the patients described here and resulted in decreased total daily doses of vancomycin, clinical improvement, and no evidence of nephrotoxicity. Although more extensive studies are necessary, the cases presented here suggest that continuous infusion vancomycin is a safe and convenient therapy for MRSA infections.

Efficacy of continuous infusion of vancomycin for the outpatient treatment of methicillin-resistant Staphylococcus aureus infections

Recently published guidelines on the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections recommend against administering vancomycin by continuous infusion on the basis of insufficient studies comparing this with intermittent infusion. We compared outcomes of patients treated with continuous infusion and intermittent infusion of vancomycin. Data for outpatients treated with continuous infusion and intermittent infusion of vancomycin were compared utilizing rates of clinical failure defined as the need for unplanned re-admission, change of antibiotics or extension of therapy. A total of 244 patients met the inclusion criteria, with 188 receiving continuous infusion and 56 intermittent infusion of vancomycin. The endpoint occurred in 21.3% and 30.4% of those receiving continuous infusion and intermittent infusion, respectively (relative risk 0.701, 95% CI 0.432-1.136, P = 0.159). Patient characteristics differed slightly between the two groups; however, logistic regression to adjust for differences in age, co-morbidity, subtherapeutic levels and prosthetic devices did not substantially alter this result. No difference in rates of clinical failure of continuous infusion and intermittent infusion of vancomycin was observed in this outpatient cohort.

Intermittent versus continuous infusion of vancomycin in neonates

ObjectiveTo compare the effectiveness of intermittent and continuous vancomycin infusions in achieving target concentrations in neonates and to assess the implications for clinical practice.MethodsThe study involved infants who required treatment...

Continuous intravenous administration of vancomycin in medical intensive care unit patients

PurposeThe aim of this study was to evaluate continuous vancomycin infusion (contV) in intensive care unit patients. Materials and MethodsA retrospective study in 164 patients treated with contV was conducted. They were compared with 75 patients treated with intermittent vancomycin infusion. ResultsThe median duration of vancomycin therapy in the contV group was 6 (5%-95% percentile range, 2-21) days. The median daily vancomycin dose in the contV group was 960 (526-1723) mg, resulting in a median serum vancomycin plateau concentration of 19.8 (9.8-29.4) mg/L (target: 15-25 mg/L). The contV administration regime was sufficient regarding achievement of the target serum vancomycin concentration. However, in the contV group, serum vancomycin levels were frequently in a subtherapeutic range on treatment days 1 (44%), 2 (29%), and 3 (23%). In the contV group, serum vancomycin concentration determinations per treatment day were performed significantly less often compared with the intermittent vancomycin infusion group (0.38 [0.15-0.75] vs 0.43 [0.22-1.00], P = .041). ConclusionsIn medical intensive care unit patients, contV is sufficient to achieve target serum vancomycin concentrations. Because contV frequently resulted in subtherapeutic drug levels on the first days of therapy, a higher loading or starting dose might be necessary.

Determinants of early inadequate vancomycin concentrations during continuous infusion in septic patients

Vancomycin is frequently administered to critically ill patients by continuous infusion in order to optimise drug efficacy; however, there are few data available on the efficacy of this strategy in septic patients. In this retrospective analysis, 261 patients treated with continuous infusion of vancomycin in the Department of Intensive Care at Hôpital Erasme (Brussels, Belgium) were evaluated. Creatinine clearance (CLCr) was calculated from 24-h urine collection and normalised to body surface area. During the study period, 139 patients (53%) had insufficient vancomycin concentrations (<20μg/mL) on Day 1 and 87 patients (33%) on Day 2. Patients who had insufficient drug concentrations on Day 1 of therapy were more likely to be men, to have a higher CLCr and to have received lower loading and daily vancomycin doses than other patients, who received greater vasopressor support and had higher Sepsis-related Organ Failure Assessment scores. In multivariate regression analysis, high CLCr and male sex independently predicted the presence of insufficient vancomycin concentrations on Days 1 and 2 of therapy. Receiver operating characteristic curve analysis for CLCr showed an area under the concentration–time curve of 0.75 (95% confidence interval 0.69–0.81) to predict insufficient drug concentrations on Day 1 of therapy. A CLCr>120mL/min/1.73m2 had a sensitivity of 26%, a specificity of 94% and an 84% positive predictive value of 84% for vancomycin concentrations <20μg/mL. In conclusion, approximately one-half of the septic Intensive Care Unit patients treated with continuous infusion of vancomycin at currently recommended doses had insufficient drug concentrations in the early phase of therapy. A high CLCr was the variable most strongly associated with insufficient drug concentrations.

Efficacy of linezolid compared to vancomycin in an experimental model of pneumonia induced by methicillin-resistant Staphylococcus aureus in ventilated pigs*

To assess the efficacy of linezolid compared with vancomycin in an experimental model of pneumonia induced by methicillin-resistant Staphylococcus aureus (MRSA) in ventilated pigs. Forty pigs (30 kg) were intubated and challenged via bronchoscopy with a suspension of 106 colony forming units of MRSA into every lobe. Afterwards, pigs were ventilated up to 96 hours. Twelve hours after bacterial inoculation, the animals were randomized into 4 groups of treatment: group 1, control; group 2, vancomycin twice daily; group 3, continuous infusion of vancomycin; and group 4, linezolid. Clinical and laboratory parameters were monitored throughout the study. Bacterial cultures of bronchoalveolar lavage fluid and lung tissue samples were performed at the end of the study. Measurements of histopathology derangements of lung samples and studies of intrapulmonary drug penetration were performed. A total of 34 animals completed the study. No differences in clinical and laboratory parameters were observed. The percentage of bronchoalveolar lavage fluid and lung tissue samples with positive cultures for MRSA in controls and groups 2, 3, and 4 was respectively 75%, 11%, 11%, and 0% (p < .01); 52%, 9%, 24%, and 2.5% (p < .01). Histopathology studies demonstrated signs of pneumonia in 95%, 69%, 58%, and 57% and signs of severe pneumonia in 48%, 29%, 22%, and 0% of controls and groups 2, 3, and 4, respectively (p < .01). In addition, pharmacokinetics/pharmacodynamics profile in serum and lung tissue showed better results for linezolid compared with both vancomycin treatments. In this animal model of MRSA pneumonia, linezolid showed a better efficacy than vancomycin showed because of a better pharmacokinetics/pharmacodynamics index.

Continuous infusion of antibiotics in the critically ill: The new holy grail for beta-lactams and vancomycin?

The alarming global rise of antimicrobial resistance combined with the lack of new antimicrobial agents has led to a renewed interest in optimization of our current antibiotics. Continuous infusion (CI) of time-dependent antibiotics has certain theoretical advantages toward efficacy based on pharmacokinetic/pharmacodynamic principles. We reviewed the available clinical studies concerning continuous infusion of beta-lactam antibiotics and vancomycin in critically ill patients. We conclude that CI of beta-lactam antibiotics is not necessarily more advantageous for all patients. Continuous infusion is only likely to have clinical benefits in subpopulations of patients where intermittent infusion is unable to achieve an adequate time above the minimal inhibitory concentration (T > MIC). For example, in patients with infections caused by organisms with elevated MICs, patients with altered pharmacokinetics (such as the critically ill) and possibly also immunocompromised patients. For vancomycin CI can be chosen, not always for better clinical efficacy, but because it is practical, cheaper, associated with less AUC24h (area under the curve >24 h)-variability, and easier to monitor.