Conil J M, Favarel H, Laguerre J, Brouchet A, Chabanon G, Cazal L, Bodnar M, Rougé D, Virenque C, Costagliola M
Département d'Anesthésie-Réanimation, CHU Rangueil, Toulouse.
Presse Med. 1994 Nov 5;23(34):1554-8.
In the severely burned patient, a marked, rapid fall in serum concentrations is often observed after intermittent infusion of vancomycin at the usual dose of 30 mg/kg. This specific "jagged" pharmokinetic course with inadequate residual concentrations raises the problem of the efficacy of this time-dependent antibiotic. Studies in patients in general resuscitation units have shown the interest of vancomycin administration in continuous infusion.
We analyzed variations in serum concentrations of vancomycin during continuous infusion in 18 patients with burns involving a mean of 40% total body surface and reported the doses necessary to maintain serum vancomycin at therapeutic levels; the possible correlations between serum vancomycin concentrations, burn parameters, age and renal function; and clinical and biological tolerance.
Higher initial doses were required in burn patients (40 mg/kg in patients aged under 60) than in other patients. Impairment of renal function is a contra-indication of continuous infusion.
This mode of administration has the advantage of ensuring greater efficacy by preventing fluctuations in serum concentrations.
