Continuous intravenous infusion of vancomycin in preterm neonates: case series from a neonatal intensive care unit

There is no standard dosing guideline available for continuous intravenous infusion (cIVI) vancomycin in the neonatal population. Vancomycin administered as cIVI is the current practice in our neonatal intensive care unit. Data from this case series provided preliminary information on dosing range of cIVI vancomycin, serum vancomycin concentration (SVC), microbiological clearance, and incidence of vancomycin-related nephrotoxicity in neonates. Clinical and laboratory data of this retrospective case series were extracted from patient’s medical record and therapeutic drug monitoring database. Of the total 36 steady-state SVCs from 15 records analysed, 64% ( n = 23) were within a therapeutic range of 15–25 mg/l. Initial SVCs were generally taken within 20–24 h, however, only 20% ( n = 3) were within therapeutic range. Loading dose given ranged between 10 and 15 mg/kg, and the mean maintenance dose was 26 ± 6.58 mg/kg/day. Most of the cases (86.7%, n = 13) were targeted treatment for infections which involved Bacillus spp , Coagulase-negative Staphylococcus (CoNS) , and methicillin-resistant Staphylococcus aureus (MRSA). Microbiological clearance was achieved in all targeted cases, and no cases of vancomycin-induced acute kidney injury were reported. This indicates vancomycin continuous infusion dosing regime in neonates seems practicable and was not associated with any incidence of nephrotoxicity.