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| |  Continuous Vancomycin Infusion for MRSA Reduces Risk of Nephrotoxicity versus Intermittent Infusion: Presented at ECCMID By Chris Berrie VIENNA, Austria -- May 12, 2011 -- Although continuous and intermittent infusion of vancomycin shows similar mortality rates for patients with Gram-positive infections, continuous vancomycin infusion is accompanied by a significant reduction in the risk of nephrotoxicity, researchers said here at the 21st European Congress of Clinical Microbiology and Infectious Diseases (ECCMID). Vancomycin is still the gold standard therapy for Methicillin-resistant Staphylococcus aureus (MRSA) infections, although there remain several issues over is use. “Among these, one of the most debated is the method of administration,” said Maria Adriana Cataldo, MD, UOC Infezioni Sistemiche e dell’Immunodepresso, “Lazzaro Spallanzani” National Institute of Infectious Diseases (INMI), Rome Italy, on May 7. Present international guidelines for vancomycin use indicate a lack of evidence to support the use of continuous infusion over intermittent infusion, although in daily practice, many clinicians prefer to administer vancomycin by continuous infusion. Dr. Cataldo and colleagues reviewed data 1 randomised clinical trial and 5 cohort studies comprising 443 patients receiving continuous or intermittent vancomycin infusion to examine mortality, nephrotoxicity, clinical failure, and adverse event (AE) rates. All but 1 study initiated vancomycin with a loading dose of 15 to 20 mg/kg, and in general continuous infusion was 30 to 40 mg/kg/day, and intermittent infusion 15 to 20 mg/kg BID. For overall mortality rates, there were no significant differences between continuous versus intermittent infusion, with an overall risk ratio of 1.03 (P =.9). However, there was a significant reduced risk of nephrotoxicity associated with continuous infusion of vancomycin, with an overall risk ratio of 0.63 (P =.02). With continuous infusion, vancomycin serum concentrations of 14 to 26 mg/L were achieved, with 10 to 30 mg/L trough levels for intermittent infusion; however, due to high heterogeneity, no pooled analysis was carried out. Only 2 studies reported on failure rates and no significant differences between the 2 treatment regimens. Only the single randomised clinical trial reported more frequent termination of vancomycin treatment due to adverse drug reactions for intermittent treatment. While noting the limitations of this analysis and that there was no conclusive evidence as to the optimal administration of vancomycin, Dr. Cataldo said that the “meta-analysis showed a significant reduction of the risk of nephrotoxicity in patients undergoing continuous infusion of vancomycin when compared with intermediate infusion.” [Presentation title: Continuous versus Intermittent Infusion of Vancomycin: The Eternal Diatribe. Abstract O46]
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