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Neonatal Intensive Care Drug Manual
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| bet | 620/654 | | Sana | 03.01.2022 | | Hajmi | 1,5 Mb. | | #14803 |
Practice points
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This is the first time the consensus group has introduced a continuous infusion regimen for vancomycin after publication of a RCT comparing continuous and intermittent regimen in newborn infants. [5]
A continuous regimen was reported to optimise achievement of steady state target concentrations with fewer dose adjustments and a lower total daily dose compared to an intermittent regimen. However, the participants’ mean birth weight (2271 g), gestation at birth (34 weeks) and current weight (2549 g) were relatively higher than populations treated by many perinatal centres. However, there are practical issues in terms of intravenous access for continuous infusion in extremely premature infants. The consensus group considered that whilst continuous infusion has better pharmacokinetic efficacy the group is not able to recommend a preferred regimen.
In this revised version, monitoring section has been further improved: Vancomycin level is not a steady state at 24 hours. Half-life varies between 3.5 to 10 hours in newborns and is longer in renal impairment, PDA, indomethacin. Also, a level at 24 hours, then 3 days later as suggested in the previous version may miss some very high steady state levels which could occur after the 50 hour mark. Changes were made in this updated version to address this issue suggesting to measure at 24 hours, then 48 hours and then every 3 days.
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