Continuous infusion vs intermittent vancomycin in neurosurgical intensive care unit patients

Abstract Purpose Target plasma level achievement has remained a challenge in neurosurgical intensive care unit patients receiving intravenous vancomycin. We evaluated continuous infusion (CI) and intermittent vancomycin dosing strategies in these patients. Methods This retrospective cohort compared...

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Bibliographic Details
Published in:Journal of critical care 2015-10, Vol.30 (5), p.1153.e1-1153.e6
Main Authors: Hong, Lisa T., PharmD, BCPS, Goolsby, Tiffany A., PharmD, BCPS (AQ-ID), Sherman, Deborah S., PharmD, Mueller, Scott W., PharmD, BCPS, Reynolds, Paul, PharmD, BCPS, Cava, Luis, MD, Neumann, Robert, MD, Kiser, Tyree H., PharmD, FCCM, FCCP, BCPS
Format: Article
Language:English
Subjects:
Acute Kidney Injury - chemically induced
Adolescent
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents - administration & dosage
Anti-Bacterial Agents - adverse effects
Anti-Bacterial Agents - blood
Continuous infusion
Critical Care
Drug dosages
Female
Humans
Infusions, Intravenous
Intensive care
Intensive Care Units
Kidney Diseases - chemically induced
Male
Middle Aged
Neurosurgery
Parmacodynamic
Pharmacokinetic
Plasma
Retrospective Studies
Review boards
Staphylococcus infections
Vancomycin
Vancomycin - administration & dosage
Vancomycin - adverse effects
Vancomycin - blood
Young Adult
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Summary:Abstract Purpose Target plasma level achievement has remained a challenge in neurosurgical intensive care unit patients receiving intravenous vancomycin. We evaluated continuous infusion (CI) and intermittent vancomycin dosing strategies in these patients. Methods This retrospective cohort compared CI vancomycin (target random levels, 20-30 mg/L) to intermittent vancomycin (target troughs, 15-20 mg/L) in regards to achievement of target plasma levels, nephrotoxicity, pharmacodynamic target attainment, and cost savings in 130 patients. Results Continuous infusion resulted in greater achievement of goal plasma concentrations at the first steady-state level (40 vs 21.5%, P = .02), more rapid achievement of goal plasma concentrations (2.04 vs 3.76 days, P < .0001), and increased time within therapeutic range (55% vs 34%, P < .0001) but no significant difference in nephrotoxicity (15.4% vs 21.5%, P = .5). Continuous infusion improved pharmacodynamic target attainment (92.3% vs 30.8%, P < .0001) and also reduced levels drawn (3.8 vs 5.7, P = .0007), dose adjustments (1.4 vs 2.4, P = .0006), days of therapy (10.4 vs 14.1, P = .01), and mean total daily dose requirements (33 vs 35.7 mg/kg, P < .0001) per patient. Conclusions Continuous infusion appears beneficial for improving attainment of target plasma concentrations, pharmacodynamic goals, and financial burden, without increasing risk of acute kidney injury.
ISSN:0883-9441
1557-8615
DOI:10.1016/j.jcrc.2015.06.012