Vancomycin in Epithelial Lining Fluid, an observational study
Research type
Research Study
Full title
Vancomycin in Epithelial Lining Fluid, an observational study
IRAS ID
166680
Contact name
Tony Whitehouse
Contact email
Sponsor organisation
QEHB
Duration of Study in the UK
2 years, 0 months, 1 days
Research summary
Vancomycin, first used in the 1950’s, is an antibiotic for the treatment of infections such as methicillin resistant staphylococcus aureus (MRSA). When MRSA causes pneumonia, it has a mortality of 30% and proper treatment is necessary to give the patient the best possible chance of survival.
Vancomycin can cause kidney, ear and nerve damage if given in overdose. Proper dosing is a balance between giving large doses to ensure proper treatment of serious infection balanced against the risk of side-effects. Vancomycin works best by having sustained high concentrations rather than fluctuating levels and a use of continuous infusion (CI) of vancomycin is the best way to achieve this. CI has been shown to achieve target levels quicker, be cheaper and easier to maintain than intermittent infusions.
To this end, the ICU at QEHB moved over to giving vancomycin by a continuous infusion (rather than a twice-daily intermittent infusion) some years ago and recently published data demonstrating that this was a safer way to avoid kidneys damage whilst giving higher antibiotic doses (Hanrahan et al 2014).
Vancomycin remains a first line recommendation for treatment of severe MRSA pneumonia. Recently, the continued use of vancomycin has been questioned. There are concerns that it’s penetration into the lung is inferior to newer drugs such as linezolid. Vancomycin administered by twice daily intermittent infusion (BDII) has been shown to be not as good as linezolid in treating MRSA pneumonias in one recent study – this has not been fully confirmed and certainly has not been substantiated for the continuous infusion.
No data exist to say that CI vancomycin gets into the lining of the lung (ELF) in ICU patients better than BDII. We propose to perform a prospective study to measure ELF levels of vancomycin on intensive care patients who are on vancomycin infusions.
REC name
East Midlands - Nottingham 1 Research Ethics Committee
REC reference
15/EM/0395
Date of REC Opinion
5 Oct 2015
REC opinion
Further Information Favourable Opinion