Vancomycin Infusion Versus Intermittent Dosing (VIVID)

• Status: Not yet recruiting
• Trial end date: 2023-09-01
• Target enrollment: 0
• Participant gender: All

Summary

Intravenous vancomycin is considered first line therapy for serious methicillin-resistant Staphylococcus aureus (MRSA) infections. The most common adverse effect of vancomycin is nephrotoxicity. The risk of nephrotoxicity may depend on vancomycin dosing and chosen target. Prior guidelines have recommended intermittent dosing and target trough level of 15-20mg/L. Newer guidelines suggested targeting area under the curve over 24 hours (AUC) greater than 400. A feasible way of AUC guided dosing is continuous infusion targeting steady state concentration of 17mg/L or greater. In prior observational studies, continuous infusion of vancomycin was associated with a lower risk of nephrotoxicity. We will be conducting a randomized controlled trial to compare continuous infusion and intermittent dosing of intravenous vancomycin for serious MRSA infections in terms of nephrotoxicity.

• Phase: N/A
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Hamilton Health Sciences Corporation
• Treatments: Vancomycin

Criteria

Inclusion Criteria:

• Adult patients with serious MRSA infections based on culture results including bacteremia, pneumonia, pleural space infection, central nervous system infection, bone infection, septic arthritis, prosthetic joint infection, and deep abscess

• Enrollment within 4 days from date of MRSA culture collection

• Patient either currently not on vancomycin or has received vancomycin for 4 days or less

Exclusion Criteria:

• Acute kidney injury at time of recruitment

• MRSA vancomycin minimum inhibitory concentration 2ug/mL or more

• Patient is palliative or expected to die in the next 48 hours

• History of type 1 hypersensitivity reaction to vancomycin

• Creatinine clearance <20 or on dialysis

• Hypotensive shock requiring vasopressors or continuous renal replacement therapy at time of recruitment