Continuous vs. Intermittent Vancomycin in Children with MRSA Infections

The study included pediatric patients ages 3 months to 18 years who were infected with MRSA
The study included pediatric patients ages 3 months to 18 years who were infected with MRSA

This article is written live from ID Week 2017 Annual Meeting in San Diego, CA. MPR will be reporting news on the latest findings from leading experts in infectious diseases. Check back for more news from IDWeek 2017.


SAN DIEGO — In a recent retrospective, cohort study presented at IDWeek 2017, vancomycin (VAN) administered via continuous infusion (CIV) was not only found to achieve the recommended VAN trough (TR) of 15–20mg/L faster but with less risk of adverse events compared to administration via intermittent infusion (IIV).

The study included pediatric patients ages 3 months to 18 years with a creatinine clearance of >30mL/min/1.73m2 who were infected with methicillin-resistant Staphylococcus aureus (MRSA). Differences in total daily dose (TDD), AUC24, and AUC24/MIC were the primary endpoints of the study. Secondary endpoints assessed adverse events. The study authors noted that only the maximum VAN levels and TDD observed in the first 72 hours of therapy were included in the analysis.

A total of 22 patients were included in the study: 11 patients in the IIV group and 11 patients in the CIV group. Baseline demographics of the groups were similar, but 45% of patients in the IIV group (5/11) received concomitant nephrotoxic drugs compared to 91% of patients in the CIV group (10/11) (P=0.03).

The study authors reported, “Patients in the IIV group received more VAN (median, mg/kg/day) (85 vs. 67, P=0.08) and had higher median AUC24 (mg*h/L (723 vs. 572, P=0.02) compared to CIV.”

Results also showed that IIV patients attained a lower median TR compared to CIV patients (16mcg/L and 25mcg/L, respectively). Additionally, for IIV patients, it took 50.9 hours (IQR 42, 70) to achieve this TR level, compared 21.5 hours (IQR 17, 34) for CIV patients (P=0.04).

A median VAN MIC of 1mcg/mL was reported for both groups. Additionally, the study authors noted, “A trend towards higher AUC24/MIC was observed in IIV group (752 vs. 621, P=0.07).” VAN-related adverse events (ie, renal toxicity, infusion reactions, and phlebitis) were experienced by 64% of IIV patients (7/11) compared to 9% of CIV patients (1/11) (P=0.01). 

For pediatric patients with MRSA infections, administration of VAN via CIV not only achieved the recommended PD target more efficiently but with a decreased risk of adverse events as well when compared to administration via IIV. 

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Reference:

Dakhlallah A, Adler-Shohet FC, Arrieta A, Tuan Tran M. Vancomycin (VAN) administered as continuous infusion (CIV) versus intermittent infusion (IIV) in children with Methicillin-Resistant Staphylococcus aureus (MRSA) infections. Poster presented at IDWeek; October 4–8, 2017; San Diego, CA. http://www.idweek.org