Comparison of Continuous and Intermittent IV Infusion of Vancomycin: Systematic Review
Bibliographic record
Abstract
Background: There is some evidence that administration of vancomycin by continuous infusion has pharmacokinetic and pharmacodynamic advantages over traditional intermittent dosing. Whether these advantages translate into clinical efficacy remains controversial.Objective: To review the literature comparing continuous infusion of vancomycin and conventional intermittent IV dosing in terms of efficacy and safety.Methods: A literature search was conducted in the PubMed/MEDLINE and Embase databases and the Cochrane Central Register of Controlled Trials, and by means of the Google search engine, and the reference lists of pertinent articles were searched manually. All human studies published in English or French that evaluated vancomycin given by continuous and intermittent IV infusion were reviewed. Articles that did not include a comparator arm and those that assessed continuous and intermittent intraperitoneal infusions were excluded. The level of evidence of each study was categorized according to the US Preventive Services Task Force rating scale.Results: In total, 9 studies were identified: 1 in a pediatric population and 8 in adult populations. Of the 3 studies with the highest quality of evidence (level I), one demonstrated pharmacodynamic advantages with continuous infusion of vancomycin. Of the 6 studies representing a moderate level of evidence (level II), 3 also favoured continuous infusion in terms of pharmacokinetic and pharmacodynamic outcomes, but the findings in terms of clinical outcomes were mixed.Conclusions: Current evidence evaluating the pharmacokinetic and pharmacodynamic advantages and clinical efficacy of continuous versus intermittent vancomycin infusions is inconsistent and does not support the routine use of continuous infusion for the treatment of multidrugresistant gram-positive infections.RÉSUMÉContexte : Selon certaines données, l'administration de vancomycine en perfusion i.v. continue aurait des avantages pharmacocinétiques et pharmacodynamiques par rapport à la perfusion i.v. intermittente traditionnelle. Cependant, il existe toujours une controverse à savoir si ces avantages se traduisent par une efficacité clinique. Objectif : Passer en revue la littérature sur l'efficacité et l'innocuité de la perfusion continue de vancomycine par rapport à la perfusion intermittente traditionnelle.Méthodes: Une recherche bibliographique a été effectuée dans les bases de données PubMed/MEDLINE et Embase et dans le Registre central Cochrane des essais randomisés, et également au moyen du moteur de recherché Google et de l'examen manuel des listes de référence des articles pertinents extraits. Toutes les études effectuées sur des humains publiées en anglais ou en français évaluant la vancomycine administrée par perfusion i.v. intermittente et continue ont été analysées. Les articles qui n'avaient pas de groupe de comparaison et ceux qui évaluaient les perfusions intrapéritonéales intermittentes et continues ont été exclus. Le niveau de données probantes pour chaque étude a été classé selon l'échelle de notation du US Preventive Services Task Force.Résultats : Au total, neuf études ont été recensées : une dans une population d'enfants et huit dans des populations d'adultes. Des trios études présentant des données probantes de la plus haute qualité (niveau I), une a démontré des avantages pharmacodynamiques de la perfusion continue de vancomycine. Des six études présentant des données probantes de qualité modérée (niveau II), trois ont aussi démontré des avantages liés à la perfusion continue sur les plans pharmacocinétique et pharmacodynamique, mais les conclusions en termes de resultants cliniques étaient mitigées.Conclusions : Les données actuelles sur l'évaluation des avantages pharmacocinétiques et pharmacodynamiques et l'efficacité clinique de la perfusion i.v. continue par rapport à la perfusion i.v. intermittente de vancomycine sont contradictoires et ne justifient pas le recours systématique à la perfusion continue pour le traitement des infections à bactéries Gram-positif multirésistantes aux antibiotiques.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.044 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.010 | 0.008 |
| Bibliometrics | 0.008 | 0.009 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".