1 | Introduction
The glycopeptide, vancomycin is a narrow-band antibacterial agent with a
triple bactericidal mechanism. It is widely used to treat severe
infections caused by gram-positive bacteria such as the
methicillin-resistant Staphylococcus aureus , Staphylococcus
epidermidis , and Enterococcus .1–4 However,
vancomycin has a narrow therapeutic window5 and is
associated with serious adverse reactions. An increase of the
drug-resistant strains as well as the phenomenon of ”MIC drift” lead to
a rampant increase in the problems like poor efficacy, prolonged
hospitalization, and high hospitalization costs. This has raised a
concern about adjusting the dosage as well as monitoring the therapy of
vancomycin worldwide. However, previous studies8–9showed that the proportion of conventional-dose administration reaching
the recommended target concentration was relatively low. Increasing the
dose of vancomycin can magnify the proportion of reaching trough
concentration but it simultaneously increases the drug-induced
nephrotoxicity. Therefore, to ensure adequate efficacy and safety, some
studies were undertaken to increase the plasma concentration of
vancomycin by prolonging the infusion time instead of increasing the
drug dose.
To date, there are limited comparative studies on continuous and
intermittent administration of vancomycin in children. Based on these
studies, it is still unclear as to which method of vancomycin infusion
and what concentration of vancomycin works better in the pediatric
population with severe infection. Therefore, in-depth and comprehensive
research is necessary to check whether the therapeutic effect can be
improved by changing the IIV and prolonging the time of infusion. Also,
studies should focus on identifying the mode of infusions of vancomycin
which does not increase the risk of the drug side
effect8–11.
Here, we report a single-center
randomized controlled trial (RCT)
of
CIV versus IIV in children in an intensive care unit (ICU). This study
determined which of the two improves the target concentrations and
AUC/MIC at the first steady-state level. Further, it also compared the
clinical prognosis and the drug-related adverse effects
between
the CIV versus IIV, to explore the optimal regimen of vancomycin in
children with a severe gram-positive bacterial infection.