Get started
Work

Continuous infusion versus intermittent infusion of vancomycin: a systematic review and meta-analysis with a focus on nephrotoxicity, target attainment, and clinical outcomes

Year: 2026
Type: review
Abstract: Objective: Vancomycin is widely used for Gram-positive infections but has a narrow therapeutic window and significant nephrotoxicity risk. Whether continuous infusion (CI) offers advantages over intermittent infusion (II) remains debated. We conducted a systematic review and meta-analysis to compare CI versus II vancomycin regarding nephrotoxicity, target attainment, clinical outcomes, and time to therapeutic target. Methods: PubMed, Embase, the Cochrane Library, and Web of Science were searched from inception to March 2026. Randomized controlled trials (RCTs) and observational studies comparing CI and II of vancomycin were included. Outcomes assessed were nephrotoxicity, target concentration attainment, clinical efficacy, microbiological clearance, mortality, and time to therapeutic target. Pooled odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects models. Results: = 67%). No significant differences were observed for clinical efficacy (OR = 1.12, 95% CI = 0.86-1.46), microbiological clearance (OR = 1.08, 95% CI = 0.72-1.62), or mortality (OR = 0.94, 95% CI = 0.71-1.25). Conclusion: Continuous infusion of vancomycin reduces nephrotoxicity risk, improves target attainment, and shortens time to therapeutic target compared with intermittent infusion, without compromising clinical efficacy or survival. These findings support CI as a preferred strategy in patients at heightened risk of renal injury. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261365683, identifier CRD420261365683.
DOI: 10.3389/fphar.2026.1868531
Language: English
Field: Medicine
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7221756633
FWCI:
Cites: 68
Cited by:
Related to: 10