Continuous versus intermittent infusion of vancomycin for the treatment of Gram-positive infections: systematic review and meta-analysis.
OBJECTIVE
To summarize available evidence on the effect of continuous infusion (CoI) of vancomycin compared with intermittent infusion (InI) in adult patients with Gram-positive infections.


METHODS
MEDLINE, EMBASE and Cochrane databases were searched. Randomized clinical trials (RCTs) and observational studies that comparatively assessed CoI and InI of vancomycin in terms of mortality, clinical cure, toxicity rates and serum drug exposure [trough concentration (C(min)) for InI and steady-state concentration (C(ss)) for CoI; area under the curve at 24 h (AUC(24)) for both] were included. Meta-analysis was conducted combining and analysing the relative risk (RR) and computing a summary RR of the effects with 95% confidence interval (CI). The standardized mean difference was calculated for continuous outcomes. The I(2) test was calculated to assess heterogeneity across studies.


RESULTS
One RCT and five observational studies were included in the analysis. Compared with InI, CoI of vancomycin was associated with a significantly lower risk of nephrotoxicity (RR 0.6, 95% CI 0.4-0.9, P = 0.02; I(2)= 0). Overall mortality was not different between the two groups (RR 1.03, 95% CI 0.7-1.6, P = 0.9; I(2)= 0).


CONCLUSIONS
Our meta-analysis suggests that administration of vancomycin for the treatment of Gram-positive infections by CoI is associated with a significantly lower risk of nephrotoxicity when compared with InI of the drug. RCTs are needed to define the impact on mortality rate and on the pharmacodynamic activity in terms of AUC/MIC ratio.
2nd Infectious Diseases Division, National Institute for Infectious Diseases, Lazzaro Spallanzani, via Portunse 292, 00149 Rome, Italy. adriana.cataldo@inmi.it
Maria Adriana
MA
Cataldo
Evelina
E
Tacconelli
Elisabetta
E
Grilli
Federico
F
Pea
Nicola
N
Petrosillo
D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy*; D006801:Humans; D007262:Infusions, Intravenous / Q000379:methods; D051437:Renal Insufficiency / Q000139:chemically induced*; D014640:Vancomycin / Q000008:administration & dosage* / Q000009:adverse effects*
D000900:Anti-Bacterial Agents; D014640:Vancomycin