Continuous vancomycin infusion reduces nephrotoxicity risk and improves target attainment in Gram-positive infectionsContinuous vancomycin infusion may lower risk of kidney damage

Frontiers in Medicine Published October 16, 2026 DOI ↗ Editorial oversight: Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

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Key Takeaway

Consider continuous vancomycin infusion for patients at high risk of renal injury to reduce nephrotoxicity and improve target attainment.

This meta-analysis evaluated the impact of continuous infusion (CI) versus intermittent infusion (II) of vancomycin in 3,053 patients with Gram-positive infections. The primary outcome of nephrotoxicity was significantly lower in the CI group (OR 0.62; 95% CI 0.48 to 0.79). Additionally, CI was associated with higher target concentration attainment (OR 2.85; 95% CI 2.12 to 3.84) and a shorter time to reach the therapeutic target (MD = -1.52 days; 95% CI -1.98 to -1.06).

Secondary outcomes, including clinical efficacy (OR 1.12; 95% CI 0.86 to 1.46), microbiological clearance (OR 1.08; 95% CI 0.72 to 1.62), and mortality (OR 0.94; 95% CI 0.71 to 1.25), showed no statistically significant differences between the continuous and intermittent infusion methods.

Clinical practice relevance suggests that continuous infusion is a preferred strategy for patients at heightened risk of renal injury. However, the association between dosing methods and outcomes is based on a mix of randomized controlled trials and observational studies. No specific limitations were reported in the source data.

How this fits prior evidence

This meta-analysis addresses a gap in optimizing vancomycin administration for patients with Gram-positive infections. While previous coverage noted that vancomycin can be linked to rare immune hemolytic anemia, this study specifically focuses on the renal safety and pharmacokinetic advantages of continuous infusion. The finding that continuous infusion reduces nephrotoxicity (OR 0.62) and improves target attainment (OR 2.85) provides a specific strategy for managing renal risk in these patients.

When patients face serious Gram-positive infections, doctors must balance fighting the bacteria with protecting the patient's organs. One major concern with the antibiotic vancomycin is nephrotoxicity, which is the medical term for kidney damage. This study looked at how the way a patient receives the drug impacts their safety.

Researchers analyzed data from over 3,000 patients. They compared giving vancomycin in a continuous infusion (a steady drip) versus an intermittent infusion (given in doses). The results showed that the continuous method led to a lower risk of kidney damage. It also helped patients reach their target drug levels faster and more consistently than the standard dosing method.

While the continuous method improved safety and speed, it did not change the overall clinical success or the rate of recovery for the patients. This finding suggests that for patients at high risk of kidney injury, a continuous drip is a preferred way to manage their treatment.

What this means for you:

Continuous vancomycin infusion may protect kidneys and reach target levels faster than intermittent dosing.

Common questions

How does continuous infusion affect kidney safety?

The study found that a continuous infusion of vancomycin resulted in lower nephrotoxicity, which means it reduced the risk of kidney damage. This makes it a preferred strategy for patients who are at a high risk of kidney injury during treatment for Gram-positive infections.

Does the way vancomycin is given change how well it works?

While the continuous infusion helped patients reach target drug levels faster and more often, it did not show a significant difference in overall clinical efficacy or the rate of microbiological clearance compared to intermittent dosing.

How much faster do patients reach target levels with a continuous drip?

Patients receiving a continuous infusion reached their therapeutic target levels about 1.52 days faster than those receiving intermittent doses. This helps ensure the medicine is working effectively against the infection as quickly as possible.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedOct 2026

View Original Abstract ↓

ObjectiveVancomycin 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.MethodsPubMed, 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.ResultsA total of 23 studies comprising 3,053 patients were included. CI was associated with significantly reduced nephrotoxicity (OR = 0.62, 95% CI = 0.48–0.79, I2 = 42%), higher target attainment (OR = 2.85, 95% CI = 2.12–3.84, I2 = 38%), and shorter time to therapeutic target (MD = –1.52 days, 95% CI = –1.98 to −1.06, I2 = 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).ConclusionContinuous 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 Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261365683, identifier CRD420261365683.

Continuous vancomycin infusion reduces nephrotoxicity risk and improves target attainment in Gram-positive infectionsContinuous vancomycin infusion may lower risk of kidney damage

How this fits prior evidence

Common questions

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Continuous vancomycin infusion reduces nephrotoxicity risk and improves target attainment in Gram-positive infectionsContinuous vancomycin infusion may lower risk of kidney damage

How this fits prior evidence

Common questions

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