Constant rate infusion of vancomycin in premature neonates: a new dosage schedule.
OBJECTIVE
Since vancomycin's bactericidal action has been shown to be time-dependent, a constant rate infusion over 24 h might result in a better bactericidal efficacy. The purpose of this study was to define a new dosage schedule in prematures.


METHODS
Two vancomycin 24 h constant rate infusion schedules were tested in two groups of neonates. Postconceptional age (PCA) was 27 to 41 weeks in group 1 (n=24) and 28 to 51.5 weeks in group 2 (n=29). Group 1 neonates received continuous infusion of 10 to 30 mgkg(-1) day(-1), adjusted for PCA and weight. Group 2 was designed to take into account the significant relationship observed in group 1 between vancomycin clearance standardized on weight and PCA and consisted of a constant loading dose of 7 mg kg(-1) followed by continuous infusion of 10 to 40 mg kg(-1) day(-1) adjusted for PCA and weight.


RESULTS
Mean vancomycin serum concentration at steady state was 11+/-3.1 mg1(-1) in group 1 and 15.4+/-6.2 mg1(-1) in group 2. Fifty-six percent of group 1 values vs 88% of group 2 values were between 10 and 30 mg at steady state (P<0.01). Both regimens were well tolerated.


CONCLUSIONS
A loading dose of vancomycin followed by constant rate infusion of the appropriate dose adjusted for PCA and weight might improve vancomycin concentrations in neonates.
Pawlotsky
F
F
Unité de Réanimation Néonatologie, Hôpital Mère et Enfant, CHU Nantes, France.
Thomas
A
A
Kergueris
M F
MF
Debillon
T
T
Roze
J C
JC
D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D005602:France; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007262:Infusions, Intravenous; D008657:Metabolic Clearance Rate; D014640:Vancomycin / Q000008:administration & dosage* / Q000493:pharmacokinetics
D000900:Anti-Bacterial Agents; D014640:Vancomycin