Analyzing the Pharmacokinetic Difference of Vancomycin 24-Hour Infusion Versus Conventional Infusion in Hospitalized Patients: A Pilot Study

Background: Methicillin-Resistant Staphylococcus aureus (MRSA) causes severe infections with high morbidity. Vancomycin remains the recommended therapy, but conventional intermittent infusion (II) requires delayed monitoring and is associated with nephrotoxicity. Continuous infusion (CI) may achieve therapeutic exposure earlier with improved renal safety.  Aim: To compare the efficacy, nephrotoxicity, and cost-effectiveness of continuous versus intermittent infusion of vancomycin in patients with MRSA infections.  Methods: A retrospective observational study was conducted at Indus Hospital, Karachi, over six months. Patients >14 years with MRSA infection receiving ≥72 hours of vancomycin were included. Participants were randomly allocated to CI (n=22) or II (n=22). Data from hospital records included demographics, dosing, serum creatinine, vancomycin levels, and costs. Outcomes were time to achieve target AUC, change in creatinine, and therapy-related costs.  Results: Baseline demographics and creatinine were comparable. CI patients had significantly smaller increases in serum creatinine (0.05 ± 0.20 vs 0.41 ± 0.76 mg/dL; p<0.05) and achieved target AUC faster (1.6 ± 1.3 vs 3.3 ± 1.5 days; p<0.05). At 48 hours, 81.8% of CI versus 50% of II patients reached target AUC (p=0.03). Treatment duration and costs were slightly lower in the CI group, though not statistically significant.  Conclusion: Continuous infusion of vancomycin achieved therapeutic exposure earlier with reduced nephrotoxicity and potential cost benefits compared to intermittent infusion. CI may be a safer and more efficient option, particularly in resource-limited settings, though larger prospective studies are required for validation.