Aims Late onset sepsis is a major cause of morbidity and mortality within the field of neonatology, with coagulase- negative staphylococci being the most commonly reported pathogens. Due to staphylococcal resistance patterns vancomycin is an essential therapeutic agent. Its efficacy correlates directly with duration of bacterial exposure at therapeutic levels. Some studies have suggested that continuous infusion achieves quicker and more sustained therapeutic levels than traditional intermittent dosing. Continuous dosing was introduced in our neonatal units in September 2015. This piece of work audits adherence to local prescribing and monitoring guidance whilst assessing the effectiveness of the new continuous regimes.
Method All infants commenced on continuous vancomycin over a six month period were included. Cases were identified via pharmacy records and data collected retrospectively and prospectively. Key areas were: loading and initial continuous doses, therapeutic drug monitoring (TDM), time spent in therapeutic range and the associated effects of gestation and baseline creatinine. Adverse effects were also considered. Data was analysed using Excel and Prism.
Results 45 treatment episodes were eligible for analysis. Corrected gestation ranged from 24+5 to 41+6. Mean weight was 1450 g and mean duration of therapy 6.5 days. Loading, initial continuous dosing and TDM were generally carried out in line with local guidelines. Regarding the first level measured after commencement of the continuous regime; 9% of levels with continuous infusion were subtherapeutic. A previous audit of intermittent vancomycin dosing showed that 50% of first levels were subtherapeutic. Statistically there was a weak correlation between creatinine level prior to commencement of continuous vancomycin and the first level. Of all 298 levels measured 56% were therapeutic, 19% were supratherapeutic and 25% subtherapeutic. Time spent in therapeutic range was comparable across the range of gestational groups.
Conclusion Continuous vancomycin dosing showed promising results in this population. Adherence to local guidelines in terms of prescribing and monitoring was good. The time taken to reach therapeutic range was shorter than previously achieved with intermittent dosing. Maintaining levels with this therapeutic range was also seen to be favourable. More detailed analysis of our results suggests that our dosing guidance is adjusted correctly to take into account important variables in vancomycin pharmacokinetics such as corrected gestational age and renal function. No adverse effects specific to vancomycin were noted during the course of this work.
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