Efficacy and Safety of Vancomycin Given by Continuous Infusion vs. Intermittent Infusion ：A Meta-analysis / 中国药房

ABSTRACT

OBJECTIVE：To compare the efficacy and safety of vancomycin given by continuous infusion vs. intermittent infusion，and to provide evidence-based reference for clinical drug use. METHODS ：Retrieved from PubMed ，the Cochrane Library，Embase，Wanfang database ，CNKI and VIP databases ，ranomized controlled trials （RCT）and cohort studies about vancomycin given by continuous infusion （trial group ）vs. intermittent infusion （control group ）were collected during the inception to Apr. 2020. After literature screening and data extraction ，the qualities of RCTs were evaluated by using bias risk evaluation tool recommended by Cochrane system evaluator manual 6.0. The qualities of cohort studies were evaluated by NOS ；Rev Man 5.3 software was used to perform Meta-analysis and publication bias analysis. RESULTS ：A total of 20 studies were included （3 RCTs and 17 cohort studies ），involving 2 380 patients in total. Results of Meta-analysis showed that ，target concentration attainment rate [RR ＝1.24，95％CI（1.12，1.38），P＜0.000 1] and attainment rate of target clinical efficacy [RR ＝1.20，95％CI（1.04，1.38）， P＝0.01] of trial group was significantly higher than those of control group. The incidence of nephrotoxicity [RR ＝0.56，95％CI （0.45，0.70），P＜0.000 01] was significantly lower than control group. There was no statistical significance in the therapeutic efficiency [RR ＝1.02，95％CI（0.95，1.10），P＝0.53]，drug treatment duration [MD ＝－0.50，95％CI（－1.40，0.39），P＝0.27] or mortality [RR ＝1.03，95％CI（0.78，1.35），P＝0.83] between 2 groups. The results of publication bias showed that the probability of publication bias was high when the incidence of nephrotoxicity was used as the index. CONCLUSIONS ：Vancomycin continuous infusion can improve the attainment rate of target concentration and target clinical efficacy ，reduce the incidence of nephrotoxicity ， but can not improve the treatment efficiency. Due to the inconsistent results of publication bias analysis ，the above conclusion needs to be interpreted carefully.