Continuous-infusion vancomycin therapy for preterm neonates with suspected or documented infections:a new dosage schedule

PLAN Odile ¹, CAMBONIE Gilles ¹, MEYER Pierre ¹, BARBOTTE Eric ², MILESI Christophe ¹, PIDOUX Odile ¹, BADR Maliha ¹ and PICAUD Jean-Charles ^1*

¹ Montpellier University Hospital, neonatology, France
² Montpellier University Hospital, département d'information médicale, France

^* To whom correspondence should be addressed. E-mail: jc-picaud{at}chu-montpellier.fr.

Accepted 23 April 2008

Abstract

Background: Intermittent infusion of vancomycin is widely used to treat late-onset sepsis in neonates. On the other hand, the continuous infusion of vancomycin could improve bactericidal efficacy since its action is time-dependent.

Objective: To evaluate a simplified dosage schedule for continuous-infusion vancomycin therapy. Methods: Prospective study in premature neonates (<34 weeks) with suspected coagulase negative staphylococci (CoNS) sepsis. Before antibiotics at time zero (T0), serum creatinine was measured and blood cultures were collected. Vancomycin dosage began with 25 or 15 mg/kg/d (period 1) and 30 or 20 mg/kg/d (period 2) depending on whether serum creatinine was below or above 90 µmol/L. Two days after beginning treatment (first timepoint: T1), serum vancomycin was measured and second blood cultures were collected.

Results: Between June 2002 and December 2005, 145 neonates were evaluated. At birth, median body weight was 920 ([Q25, Q75]: [500, 1160]) g and gestational age was 28 [26, 29] weeks. At T1, serum vancomycin was within the required range in 74.5% of neonates (108/145). Serum vancomycin levels were higher in period 2 than in period 1 (20 mg/L versus 13 mg/L, p<0.05). At T0, 55% (80/145) of blood cultures were positive for CoNS, but 71% (57/80) were negative at T1. Four days after beginning treatment, 92% of subjects had recovered without removing the central venous catheter.

Conclusion: Using this simplified dosage schedule, bactericidal efficacy was maintained and most subjects had serum vancomycin concentrations within the therapeutic range.