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Do continuous vancomycin infusions achieve therapeutic target levels more often than intermittent dosing in neonates?
  1. Marianna Vidouris1,
  2. Rohit Kumar2,
  3. Prakash Kannan Loganathan2
  1. 1Health Education England North East, Newcastle upon Tyne, UK
  2. 2Neonatal Intensive Care Unit, James Cook University Hospital, Middlesbrough, UK
  1. Correspondence to Dr Marianna Vidouris, James Cook University Hospital, Middlesbrough TS4 3BW, UK; marianna.vidouris{at}nhs.net

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Scenario

A 13-day-old baby born at a gestational age of 26 weeks in the neonatal intensive care unit is noted to have an increasing oxygen requirement, frequent apnoeas and to develop temperature instability. You note that she has had a central line in situ for 12 days for feeding intolerance and parenteral nutrition. Central line sepsis is considered as one of the differential diagnoses and your unit policy is to use vancomycin to treat this. You wonder whether to use an intermittent dosing regimen or a continuous infusion of vancomycin.

Structured clinical question

In a neonate with suspected or confirmed sepsis (patient), does a continuous vancomycin dosing regimen (intervention) compared with an intermittent dosing regimen (comparison) achieve therapeutic levels (outcome) more frequently without an increase in side effects?

Search

A literature search was performed in EMBASE, Cumulative Index to Nursing and Allied Health Literature and MEDLINE databases, from inception to February 2019. Included were all studies with a neonatal population that provided a comparison between intermittent and continuous regimen of vancomycin with the primary outcome of achieving target levels. The keywords used were vancomycin, dosing, levels, intermittent, continuous and neonate.

Output

All 36 citations were screened by title and abstract. If the …

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