Continuous versus intermittent infusion of vancomycin in adult patients: A systematic review and meta-analysis

• Meta-analysis of 11 studies to assess the efficacy and safety of continuous infusion of vancomycin (CIV) versus intermittent infusion of vancomycin (IIV) in adult patients with infections.
• Patients treated with CIV had a significantly lower incidence of nephrotoxicity compared with those receiving IIV. No significant difference in treatment failure was detected. Mortality between patients receiving CIV and those receiving IIV was similar.
• Meta-analysis showed that CIV had superior safety compared with IIV, whilst clinical efficacy showed no significant difference.
• Well-designed multicentre RCTs are needed to determine whether CIV has an advantage in the treatment of infection.

Continuous infusion of vancomycin (CIV) and intermittent infusion of vancomycin (IIV) are two major administration strategies in clinical settings. However, previous articles comparing the efficacy and safety of CIV versus IIV showed inconsistent results. Therefore, a meta-analysis was conducted to compare the efficacy and safety of CIV and IIV. PubMed, the Cochrane Library and Web of Science up to June 2015 were searched using the keywords ‘vancomycin’, ‘intravenous’, ‘parenteral’, ‘continuous’, ‘intermittent’, ‘discontinuous’, ‘infusion’, ‘administration’ and ‘dosing’. Eleven studies were included in the meta-analysis. Neither heterogeneity nor publication bias were observed. Patients treated with CIV had a significantly lower incidence of nephrotoxicity compared with patients receiving IIV [risk ratio (RR) = 0.61, 95% confidence interval (CI) 0.47–0.80; P < 0.001]. No significant difference in treatment failure between the two groups was detected. Mortality between patients receiving CIV and patients receiving IIV was similar (RR = 1.15, 95% CI 0.85–1.54; P = 0.365). This meta-analysis showed that CIV had superior safety compared with IIV, whilst the clinical efficacy was not significantly different. A further multicentre, randomised controlled trial is required to confirm these results.