title: Neonatal vancomycin continuous infusion: still a confusion?
abstract: BACKGROUND
  Continuous infusions of vancomycin over 24 hours have been shown in adults to reduce drug toxicity, lower treatment costs and require fewer blood samples for therapeutic drug monitoring. They may also improve clinical outcome through earlier attainment of target drug concentrations. In neonates, there is no consensus on vancomycin dosing. We reviewed the literature to assess the evidence for vancomycin dosing regimens for continuous infusion in neonates.
  
  
  METHODS
  Medline and Embase were searched for studies about continuous vancomycin dosing regimens in neonates that reported serum drug concentrations. The search identified 469 articles, of which 5 were relevant.
  
  
  RESULTS
  Five prospective studies were included; 2 studies used non-linear mixed effects modeling. Vancomycin was administered with parenteral nutrition or 5% dextrose. Target serum concentrations varied (range: 10-30 mg/L). Four studies used loading doses before continuous infusion; only 1 documented achievement of therapeutic concentrations after the load. The time to a therapeutic concentration was not reported for the other studies. Attainment of target concentrations ranged from 56% to 89% of measurements. Only 1 study compared intermittent to continuous infusions, reporting higher attainment of target concentrations with continuous dosing (82% vs. 46%). No adverse effects were reported, although 3 neonates developed a reversible raised serum creatinine in the setting of septicemia.
  
  
  CONCLUSIONS
  Continuous infusions of vancomycin in neonates are well tolerated, require less blood sampling and may result in improved attainment of target concentrations. Further prospective studies are needed in this population.
authors.affiliation: From the *Department of General Medicine, The Royal Children's Hospital Melbourne; †Infectious Diseases & Microbiology group, Murdoch Childrens Research Institute; ‡Department of Paediatrics, The University of Melbourne; §Centre for International Health, Burnet Institute; ¶Department of Epidemiology and Preventive Medicine, Monash University; and ‖Department of Microbiology, The Royal Children's Hospital Melbourne, Victoria, Australia.
authors.forename: Amanda
authors.initials: A
authors.lastname: Gwee
authors.forename: Noel
authors.initials: N
authors.lastname: Cranswick
authors.forename: David
authors.initials: D
authors.lastname: Metz
authors.forename: Benjamin
authors.initials: B
authors.lastname: Coghlan
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Daley
authors.forename: Penelope A
authors.initials: PA
authors.lastname: Bryant
authors.forename: Nigel
authors.initials: N
authors.lastname: Curtis
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D016903:Drug Monitoring; D006801:Humans; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D009359:Neonatology / Q000379:methods; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D014640:Vancomycin / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin