title: Continuous infusion vs intermittent vancomycin in neurosurgical intensive care unit patients.
abstract: OBJECTIVE
  Target plasma level achievement has remained a challenge in neurosurgical intensive care unit patients receiving intravenous vancomycin. We evaluated continuous infusion (CI) and intermittent vancomycin dosing strategies in these patients.
  
  
  METHODS
  This retrospective cohort compared CI vancomycin (target random levels, 20-30 mg/L) to intermittent vancomycin (target troughs, 15-20 mg/L) in regards to achievement of target plasma levels, nephrotoxicity, pharmacodynamic target attainment, and cost savings in 130 patients.
  
  
  RESULTS
  Continuous infusion resulted in greater achievement of goal plasma concentrations at the first steady-state level (40 vs 21.5%, P = .02), more rapid achievement of goal plasma concentrations (2.04 vs 3.76 days, P < .0001), and increased time within therapeutic range (55% vs 34%, P < .0001) but no significant difference in nephrotoxicity (15.4% vs 21.5%, P = .5). Continuous infusion improved pharmacodynamic target attainment (92.3% vs 30.8%, P < .0001) and also reduced levels drawn (3.8 vs 5.7, P = .0007), dose adjustments (1.4 vs 2.4, P = .0006), days of therapy (10.4 vs 14.1, P = .01), and mean total daily dose requirements (33 vs 35.7 mg/kg, P < .0001) per patient.
  
  
  CONCLUSIONS
  Continuous infusion appears beneficial for improving attainment of target plasma concentrations, pharmacodynamic goals, and financial burden, without increasing risk of acute kidney injury.
authors.affiliation: Department of Pharmacy, University of Colorado Hospital, Aurora, CO, USA.
authors.forename: Lisa T
authors.initials: LT
authors.lastname: Hong
authors.affiliation: Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
authors.forename: Tiffany A
authors.initials: TA
authors.lastname: Goolsby
authors.affiliation: Department of Pharmacy, University of Colorado Hospital, Aurora, CO, USA.
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Sherman
authors.affiliation: Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
authors.forename: Scott W
authors.initials: SW
authors.lastname: Mueller
authors.affiliation: Department of Pharmacy, University of Colorado Hospital, Aurora, CO, USA; Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Reynolds
authors.affiliation: Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: Luis
authors.initials: L
authors.lastname: Cava
authors.affiliation: Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Neumann
authors.affiliation: Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA. Electronic address: Ty.Kiser@ucdenver.edu.
authors.forename: Tyree H
authors.initials: TH
authors.lastname: Kiser
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D003422:Critical Care; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D007674:Kidney Diseases / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014640:Vancomycin / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: Continuous infusion; Neurosurgery; Parmacodynamic; Pharmacokinetic; Vancomycin