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Aim Therapeutic drug monitoring of intermittent infusions of the glycopeptide antibiotic, vancomycin, has demonstrated that achievement of target serum concentrations is often delayed in paediatrics which may adversely affect clinical outcomes when used in indications such as Central Line-associated Bloodstream Infections (CLABSI). 1 This audit aimed to explore whether administering vancomycin as a continuous infusion for patients in the Neonatal Intensive Care Unit (NICU) at a specialised paediatric hospital would increase the number of patients that reached therapeutic range with the first level taken, without increasing the risk of patient harm, particularly concerning nephrotoxicity.2 Methods Patients admitted to NICU who were prescribed continuous vancomycin infusions between 27th November 2024 and 31st January 2025 were identified using the EPIC system and using patients‘ electronic medical records. A comprehensive dataset was collected and recorded on an Excel spreadsheet including patient details (age, weight, gender), the clinical indication for vancomycin use, dosage information (including the dose administered and the timing of initial loading and maintenance doses) and the time of the initial vancomycin level measurement. Data was then analysed to determine whether the initial vancomycin level was within target range (15-25mg/L). For patients who failed to initially reach target therapeutic range, any dose increments and the time taken to subsequently reach therapeutic range was recorded. Renal function was also monitored throughout the treatment period by assessing creatinine levels to detect any potential renal impairment, and any concomitant nephrotoxic agents were noted.Results During the two-month data collection period, 34 administrations of continuous vancomycin were identified and 58.8% (20/34) of these reached target serum concentrations with the first level taken. Among those which did not initially reach target therapeutic range, 9 were subtherapeutic and 5 were toxic. Following subsequent dose adjustments, therapeutic range was achieved in 76.5% (26/34) of patients within 48 hours of the administration of the loading dose and in 91.2% (31/34) of patients within 72 hours of the loading dose. Target vancomycin serum levels were never reached in 8.82% (3/34) of patients likely because treatment was discontinued before the effects of dose adjustments could be fully evaluated. Additionally, 97.1% (33/34) of patients did not experience any negative impact on renal function and the 2.94% (1/34) that did experience an increase in creatinine from 54 µmol/L to 79 µmol/L was concomitantly taking the nephrotoxic drug, cytarabine and thus the vancomycin was discontinued.Conclusion This study highlights that continuous infusions of vancomycin demonstrate an improvement in the number of patients reaching target vancomycin serum levels with the first level taken compared to intermittent infusions. However, continued investigation is needed via implementation of the continuous vancomycin guideline on other wards of the hospital to obtain a wider dataset and to observe how the new dosing affects different patient groups.References Salem M, Khalil A, Mohamed A, et al. Evaluation of vancomycin initial trough levels in children: A 1-year retrospective study. SAGE Open Medicine 2020;8:2050312120951058.Germovsek E, Osborne L, Gunaratnam, F, et al. Development and external evaluation of a population pharmacokinetic model for continuous and intermittent administration of vancomycin in neonates and infants using prospectively collected data. Journal of Antimicrobial Chemotherapy 2019;74:1003–1011.