Background Late onset sepsis (>48hr of life) affects about 7% of all neonatal unit admissions and is predominantly caused by coagulase negative staphylococci (CoNS).1 Vancomycin remains the most frequently used antibiotic to treat CoNS sepsis. It is vital to maintain adequate trough [vancomycin] (currently 10–15µg/ml) to achieve its bactericidal activity and prevent emergence of resistance.1 Currently there are different dosing regimens of vancomycin, e.g. intermittent bolus administration (IVanc) and loading dose followed by continuous infusion (CVanc) and insufficient evidence to support one over the other.
Aims to determine
The efficacy of IVanc in achieving adequate trough levels
The different dosing regimens of vancomycin used in UK NICUs
An audit was conducted on the neonatal unit at Birmingham Women’s Hospital during two epochs, January-February and September–October 2013, to determine the number of trough levels of vancomycin measured that were in the desired range. Demographic characteristics were also collected.
A national telephone survey of all the tertiary NICUs was conducted
Ivanc was administered to 44 neonates (9% of all admissions). median gestation was 27w (26–28) and birth weight 775 g (645–830). median corrected gestation at administration was 32w (29–;33). 155 trough [vancomycin] were measured: 28% were in the desired range (10–15), 40% were sub-therapeutic (<10) and 32% were supra therapeutic (>15). the median duration to achieve therapeutic level was 5 doses.
Of 51 UK NICUs contacted only 9 used CVanc.
Conclusion IVanc provides the desired therapeutic [Vancomycin] in 30% neonates. Single centre studies have demonstrated the superiority of CVanc in achieving improved [Vancomycin]2 but only a minority of UK NICUs use this regimen. We believe a national consensus is urgently required to direct clinicians towards the optimal dosing regimen of vancomycin.
Russell AB, Sharland M, Heath PT. Improving antibiotic prescribing in neonatal units: time to act. Arch Dis Child Feta Neonatal. 2012;97(2):F141-F146
Patel AD, Anand D, Lucas C, Thomson AH. Intermittent versus continuous infusion of vancomycin in neonates. Arch Dis Child. 2012;97:e20