Continuous versus Intermittent Infusion of Vancomycin in Severe Staphylococcal Infections: Prospective Multicenter Randomized Study

A higher dose of vancomycin in continuous infusion is needed in critically ill patients

“…Accordingly, application of continuous infusion with a target plateau concentration of 20-25 mg/L may be helpful in maximising the pharmacodynamics of vancomycin against staphylococcal infections while avoiding the risk of nephrotoxicity. Continuous infusion of vancomycin to obtain plateau concentrations of 20-25 mg/L is safe and shows good clinical efficacy [3]. The efficacy of vancomycin is optimal when the 24-h AUC/MIC ratio is ≥400 [11].…”

“…and logistically more convenient, achieves target concentrations faster, results in less variability in serum concentrations and requires less therapeutic drug monitoring (TDM) [3]. Furthermore, in patients with normal renal function, vancomycin in continuous infusion is associated with a slower onset of nephrotoxicity [4].…”

Treatment options for methicillin-resistant Staphylococcus aureus (MRSA) infection: Where are we now?

“…CI of vancomycin in a pig lung model showed evidence for increased efficacy [53], but clinical experience is limited [54,55]. A clinical trial in intensive care unit (ICU) patients did not show better outcome using CI but it was associated with an earlier achievement of desired trough concentrations, and concentrations were more stable over time [56]. In addition, a meta-analysis showed decreased nephrotoxicity with CI [57]; however, patients included in some of the articles were outpatients and so with a lower risk of developing nephrotoxicity.…”

Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention

“…Changes in medication frequency or infusion rates can increase the time that the antibiotic concentration exceeds the MIC. For ␤-lactams, monobactams, glycopeptides, and cabapenems this can be important in enhancing bactericidal activity, again reducing opportunities for resistant organisms to emerge (18,19,105,120,217).…”

“…2). Coupling an understanding of the mechanisms of how bacteria are eradicated and PK/PD parameters results in reduced mortality and morbidity (3,4,18,84,120,151,152,177,217).…”