Review of Continuous-Infusion Vancomycin

OBJECTIVE: To evaluate the efficacy and safety of administering vancomycin as a continuous infusion. DATA SOURCES: 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. STUDY SELECTION AND DATA EXTRACTION: 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. DATA SYNTHESIS: 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. CONCLUSIONS: 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.