Intermittent vs. continuous vancomycin infusion for gram-positive infections: A systematic review and meta-analysis

Objective: The clinical use of intermittent infusion of vancomycin (IIV) and continuous infusion of vancomycin (CIV) is controversial. The aim of this study was to assess the effectiveness and safety of IIV and CIV by using a meta-analysis for cohort studies and randomized controlled trials. Methods: We compared the probabilities of target attainment (PTA) for the measured concentration (C-m) >= the target concentration (Ce), the PTA for the area under the drug concentration curve/minimal inhibitory concentration (AUC/MIC) >400, the duration of treatment, nephrotoxicity, and overall mortality after vancomycin treatment as reported in PubMed, Embase, Cochrane, and Web of Science. Results: A total of 14 studies with 1640 patients were included in the meta-analysis. For IIV, the PTA of C-m > Cr (RR = 0.72, 95% CI =0.60-0.88), and nephrotoxicity (RR =1.70, 95% CI =1.34-2.14) were significantly different from those of CIV. The treatment duration (SMD = 0.08, 95% CI = -0.08-0.25), the PTA of AUC/MIC > 400 (RR =0.84, 95% CI =0.70-1.00) and mortality (RR = 0.94, 95% CI = 0.72-1.25) were not significantly different from those of CIV. Conclusions: The results showed that CIV was easier to achieve Cr and safer than IIV. Additional randomized controlled trials focusing on the concentration of vancomycin are needed for further analysis. (C) 2019 The Authors. Published by Elsevier Limited on behalf of King Saud Bin Abdulaziz University for Health Sciences.