Background and importance In adults, continuous infusion of vancomicyn (CIV) has been evaluated as an alternative to intermittent infusion (IIV) with potential advantages. The limited evidence in the paediatric population has not allowed the routine use of CIV.
Aim and objectives To identify and assess the available evidence on the safety and efficacy of CIV in paediatric patients.
Material and methods A systematic review of the literature indexed in PubMed and EMBASE databases and published before November 2020 was conducted, in accordance with the PRISMA Statement. The search terms included: ‘Vancomycin’ AND ‘Pediatric OR Child OR Children OR Infant’ AND ‘Continuous infusion’. The inclusion criteria were: clinical trials (CTs) and observational studies that assessed the clinical efficacy and/or attainment of plasma concentrations of vancomycin (pharmacokinetic efficacy) in paediatric patients treated with CIV. The exclusion criteria were: adults and the neonatal population and studies in a language other than English or Spanish. The data collected included: year of publication, type of study, characteristics of population, as well as efficacy and safety data on CIV.
Results A total of 359 articles were identified, of which 7 met the inclusion criteria. The studies included were published between 2012 and 2019. Regarding the type of study, there was 1 CT, 3 case series studies, 2 retrospective studies and 1 prospective study. The analysed population (n=460) consisted of critical paediatric (n=34), cystic fibrosis (n=3), onco-haematological (n=94), and osteomyelitis and pneumonia (n=15) patients, as well as various subpopulations (n=314). All the articles (n=7) assessed the attainment of plasma concentrations of vancomycin. The percentage of patients with concentrations within the therapeutic range varied among the different studies from 0% to 100% of the total study population. Only 3 studies assessed clinical efficacy, but none of them were designed for this purpose. Only 2 of the 6 studies observed cases of nephrotoxicity with 11% (n=10) and 12% (n=3) of the total population, respectively.
Conclusion and relevance The best administration method for this antibiotic within the paediatric population is still unknown due to limited evidence. However, studies conducted thus far suggest pharmacokinetic advantages for CIV. Further investigation is required, in particular CTs comparing IIV with CIV for clinical efficacy and safety outcomes
Conflict of interest No conflict of interest
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