Background Late onset sepsis (>48 hr of life) in neonates is predominantly caused by coagulase negative staphylococci (CoNS).¹ Vancomycin remains the most frequently used antibiotic to treat CoNS sepsis. It is vital to maintain adequate trough [Vancomycin] to achieve its bactericidal activity and prevent emergence of resistance.¹ There are different dosing regimens of vancomycin, e.g. intermittent bolus administration (IVanc) and continuous infusion (CVanc) with insufficient evidence to support one over the other.

Aims To determine

1. the efficacy of IVanc in achieving adequate trough levels

2. the different dosing regimens of vancomycin used in UK NICUs.

Methods

1. An audit was conducted at Birmingham Women’s Hospital during two epochs, January–February and September–October 2013, to determine the number of trough [Vancomycin] measured that were in the desired range.

2. A national telephone survey of all UK tertiary NICUs was conducted.

Results

1. IVanc was administered to 44 neonates (9% of all admissions). Median gestation was 27wk(26–28) and birth weight 775g(645–830) Median corrected gestation at administration was 32w (29–33). 155 trough [Vancomycin] were measured: 28% were in the desired range (10–15), 40% were sub-therapeutic (<10) and 32% were supra therapeutic (>15). The median duration to achieve therapeutic level was 5 doses.

2. Of 51 UK NICUs contacted 8 used CVanc.

Conclusion IVanc provides the desired therapeutic [Vancomycin] in 30% neonates. Single centre studies have demonstrated the superiority of CVanc over IVanc² but only a minority of UK NICUs use this regimen. We believe a national consensus is urgently required to direct clinicians towards the optimal dosing regimen of vancomycin.

References

1. Russell AB, Sharland M, Heath PT. Improving antibiotic prescribing in neonatal units: time to act. Arch Dis Child Feta Neonatal. 2012;97(2):F141–F146

2. Patel AD, Anand D, Lucas C, Thomson AH. Intermittent versus continuous infusion of vancomycin in neonates. Arch Dis Child. 2012;97:e20