Continuous versus intermittent infusion of vancomycin in severe staphylococcal infections: Prospective multicenter randomized study

A continuous infusion of vancomycin (CIV) may provide an alternative mode o f infusion in severe hospital-acquired methicillin-resistant staphylococcal (MRS) infections. A multicenter, prospective, randomized study was designe d to compare CIV (targeted plateau drug serum concentrations of 20 to 25 mg /liter) and intermittent infusions of vancomycin (IIV; targeted trough drug serum concentrations of 10 to 15 mg/liter) in 119 critically ill patients with MRS infections (bacteremic infections, 35%; pneumonia, 45%). Microbiol ogical and clinical outcomes, safety, pharmacokinetics, ease of treatment a djustment, and cost were compared. Microbiological and clinical outcomes an d safety were similar. CIV patients reached the targeted concentrations fas ter (36 +/- 31 versus 51 +/- 39 h, P = 0.029) and fewer samples were requir ed for treatment monitoring than with IIV patients (7.7 +/- 2.2 versus 11.8 +/- 3.9 per treatment, P < 0.0001). The variability between patients in bo th the area under the serum concentration-time curve (AUC(24h)) and the dai ly dose given over 10 days of treatment was lower with CIV than with IIV (v ariances, 14,621 versus 53,975 mg(2)/liter(2)/h(2) [P = 0.026] and 414 vers us 818 g(2) [P = 0.057], respectively). The 10-day treatment cost per patie nt was $454 +/- 137 in the IIV group and was 23% lower in the CIV group ($3 21 +/- 81: P < 0.0001). In summary, for comparable efficacy and tolerance, CIV may be a cost-effective alternative to IIV.