Role of continuous infusion in Bayesian-assisted vancomycin dosing guided by area under the concentration-time curve in adults: A scoping review with case series

Abstract

Introduction

Continuous infusion (CI) of vancomycin offers potential benefits in achieving therapeutic drug levels and reducing nephrotoxicity compared to intermittent infusion (IntI). However, no studies from Japan have evaluated CI in detail. This study presents a scoping review with the relevant case series to assess the role of CI in Bayesian-assisted AUC-guided vancomycin dosing.

Methods

The scoping review was performed using PubMed, Web of Science, and Cochrane Library to identify studies published between 2018 and 2024. Data included study design, dosing methods, AUC estimation techniques, outcomes of nephrotoxicity, and therapeutic target achievement. The retrospective analysis was conducted on 15 cases treated with CI at Kumamoto University Hospital. Demographics, nephrotoxicity, and mortality outcomes were analyzed.

Results

The scoping review identified 10 studies, including one randomized controlled trial. Most studies relied on trough concentrations as surrogates for AUC in IntI groups, despite guidelines recommending against this approach. Target exposures for CI varied, with few studies aligning with AUC-guided dosing ranges of 400–600 μg h/mL. Of 15 cases included, four required increased dosing due to high creatinine clearance (CCr), achieving therapeutic targets without nephrotoxicity or mortality. The remaining 11 cases demonstrated variable outcomes, with only 45.5 % achieving therapeutic targets and 54.5 % developing nephrotoxicity.

Conclusions

Although the scoping review highlighted the need for further studies to optimize dosing strategies and clarify the comparative benefits of CI versus Bayesian-assisted IntI, CI may offer potential advantages in achieving therapeutic targets, particularly for adults requiring higher doses, such as those exceeding 3–4 g/day.