title: Comparison of Continuous and Intermittent IV Infusion of Vancomycin: Systematic Review.
abstract: BACKGROUND
  There is some evidence that administration of vancomycin by continuous infusion has pharmacokinetic and pharmacodynamic advantages over traditional intermittent dosing. Whether these advantages translate into clinical efficacy remains controversial.
  
  
  OBJECTIVE
  To review the literature comparing continuous infusion of vancomycin and conventional intermittent IV dosing in terms of efficacy and safety.
  
  
  METHODS
  A literature search was conducted in the PubMed/MEDLINE and Embase databases and the Cochrane Central Register of Controlled Trials, and by means of the Google search engine, and the reference lists of pertinent articles were searched manually. All human studies published in English or French that evaluated vancomycin given by continuous and intermittent IV infusion were reviewed. Articles that did not include a comparator arm and those that assessed continuous and intermittent intraperitoneal infusions were excluded. The level of evidence of each study was categorized according to the US Preventive Services Task Force rating scale.
  
  
  RESULTS
  In total, 9 studies were identified: 1 in a pediatric population and 8 in adult populations. Of the 3 studies with the highest quality of evidence (level I), one demonstrated pharmacodynamic advantages with continuous infusion of vancomycin. Of the 6 studies representing a moderate level of evidence (level II), 3 also favoured continuous infusion in terms of pharmacokinetic and pharmacodynamic outcomes, but the findings in terms of clinical outcomes were mixed.
  
  
  CONCLUSIONS
  Current evidence evaluating the pharmacokinetic and pharmacodynamic advantages and clinical efficacy of continuous versus intermittent vancomycin infusions is inconsistent and does not support the routine use of continuous infusion for the treatment of multidrug-resistant gram-positive infections.
authors.affiliation: , BSc(Pharm), PharmD, is Provincial Pharmacy Education Coordinator, BC Cancer Agency, Vancouver British Columbia. At the time of writing, she was a Doctor of Pharmacy student in the Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia.
authors.forename: Sally S K
authors.initials: SS
authors.lastname: Man
authors.forename: Roxane R
authors.initials: RR
authors.lastname: Carr
authors.forename: Mary H H
authors.initials: MH
authors.lastname: Ensom