Continuous <i>vs.</i> intermittent cefotaxime administration in patients with chronic obstructive pulmonary disease and respiratory tract infections: pharmacokinetics/pharmacodynamics, bacterial susceptibility and clinical efficacy

Zanten, Arthur R. H. van; Oudijk, Martijn A.; Nohlmans-Paulssen, M.K.E.; Meer, Y. G. Van Der; Girbes, Arj; Polderman, Kees H.

doi:10.1111/j.1365-2125.2006.02730.x

Cited by 53 publications

(56 citation statements)

References 24 publications

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“…Van Zanten et al, reported similar clinical success rates in patients with acute exacerbations of COPD receiving either CI or thrice-daily administration of cefotaxime [257]. [374].…”

Section: Mortalitymentioning

confidence: 86%

“…Numerous clinical comparative studies have been conducted with beta-lactams testing various dosing strategies in various patient populations including critically ill patients [85,86,151,166,169,171,172,[241][242][243][246][247][248][249][250][251][252], patients receiving extracorporeal renal circuit [244,245,253], trauma patients [254], patients with malignant diseases [255], patients with intra-abdominal infections [256], patients with chronic obstructive pulmonary disease (COPD) [257,258] and nonspecific hospitalized patients [173,[259][260][261][262] (Table 1-2). These studies have not shown whether alternative dosing approaches (i.e., CI and EI) are advantageous nor which patient groups may benefit.…”

Section: Clinical Outcomesmentioning

confidence: 99%

“…The diverse range of patient groups include critically ill patients with sepsis [151,172,243,248,261,262,266], trauma patients (86), patients with abdominal infections [256,407], COPD patients [257,258], cancer [255] and non-specific hospitalized infections [173]. Thus, meta-analyses have evaluated heterogeneous patient groups and any potential benefits of CI or IB that may exist in a particular patient group were not assessed.…”

Section: Heterogeneous Patient Populationsmentioning

confidence: 99%

“…Most of the studies included in the three meta-analyses utilized higher IB doses than the CI treatment arm, potentially favouring the former [151,171,173,248,254,256,257,266] (Table 5-3). This treatment bias might have skewed the results of these meta-analyses towards the null hypothesis.…”

Section: Inconsistent Antibiotic Dosing Regimenmentioning

confidence: 99%

“…Only a number of studies measured antibiotic concentrations and included a concurrent PK/PD evaluation to confirm whether the dosing approaches were actually meeting their respective PK/PD end-points (Table 5-3) [82,171,248,254,256,257]. Hence, it is difficult to relate clinical outcomes to the respective antibiotic exposure obtained via the two approaches.…”

Section: End-pointsmentioning

confidence: 99%

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Optimizing beta-lactam antibiotic dosing in critically ill patients: Prolonged infusion versus intermittent bolus administration

Abdul‐Aziz¹,

Mohd²

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Severe sepsis is a major burden in the intensive care unit (ICU) with persistently high mortality rates. Optimization of antibiotic dosing has been suggested as an intervention to improve clinical outcomes for critically ill patients with severe sepsis. However, current antibiotic dosing guidelines may not be appropriate for these patients, as they rarely consider the altered physiology and illness severity associated with this population. Optimizing antibiotic dosing using pharmacokinetic (PK) and pharmacodynamic (PD) principles can address these critical illness-related changes and promote therapeutic success. Due to their wide spectrum of antibiotic activity and excellent safety profile, beta-lactam antibiotics are commonly used for severe infections in the ICU. Two alternative dosing approaches to traditional intermittent bolus (IB) dosing, namely continuous infusion (CI) and extended infusion (EI), have been suggested to maximize the therapeutic potential of these antibiotics in critically ill patients. Collectively, the two dosing approaches can also be referred as prolonged infusion (PI).This Thesis aims to better characterize the pharmacokinetics/pharmacodynamics (PK/PD) of betalactam antibiotics to determine whether there is any therapeutic advantage associated with PI dosing (CI and/or EI) as compared to IB dosing. This Thesis comprises of eight chapters. Chapter 1 is an introductory chapter which provides an overview of the published literature on the area of research. The discussion in Chapter 1 presents a theoretical framework behind the Thesis objectives. Chapter 1 concludes with the specific aims of this Thesis.Chapter 2 reports the findings of a prospective PK study which aimed to describe the population PK of doripenem in critically ill patients with sepsis and perform dosing simulations to develop clinically relevant dosing guidelines for these patients. Twelve critically ill participants receiving 500 mg of doripenem 8-hourly as a 1-hr infusion were enrolled. The volume of distribution (Vd) and clearance (CL) of doripenem in this patient cohort were substantially different than those usually described in non-critically patients. As current dosing guidelines were mostly derived from the non-critically ill, findings from this study suggest that the licensed "one-dose-fits-all" dosing for doripenem is unlikely to achieve optimal exposures in critically ill patients. Empirical use of PI dosing should be considered to account for PK and illness severity differences, particularly when less-susceptible pathogens are involved.ii Chapter 3 incorporates a published systematic review which compares the PK/PD data and clinical outcomes between CI and IB dosing to describe any potential merits supporting either of the two dosing approaches for critically ill patients. The findings suggest that beta-lactam CI may not be advantageous for all critically ill patients and may be beneficial in patients with severe infections.Chapter 4 describes the findings of a post hoc analysis on the Defining...

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“…Van Zanten et al, reported similar clinical success rates in patients with acute exacerbations of COPD receiving either CI or thrice-daily administration of cefotaxime [257]. [374].…”

Section: Mortalitymentioning

confidence: 86%

Section: Clinical Outcomesmentioning

confidence: 99%

Section: Heterogeneous Patient Populationsmentioning

confidence: 99%

Section: Inconsistent Antibiotic Dosing Regimenmentioning

confidence: 99%

Section: End-pointsmentioning

confidence: 99%

See 3 more Smart Citations

Optimizing beta-lactam antibiotic dosing in critically ill patients: Prolonged infusion versus intermittent bolus administration

Abdul‐Aziz¹,

Mohd²

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Continuous versus intermittent infusions of antibiotics for the treatment of severe acute infections

Shiu

Wang

Tejani

et al. 2013

Cochrane Database of Systematic Reviews

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International consensus recommendations for the use of prolonged‐infusion beta‐lactam antibiotics: Endorsed by the American College of Clinical Pharmacy, British Society for Antimicrobial Chemotherapy, Cystic Fibrosis Foundation, European Society of Clinical Microbiology and Infectious Diseases, Infectious Diseases Society of America, Society of Critical Care Medicine, and Society of Infectious Diseases Pharmacists

Hong,

Downes,

FakhriRavari

et al. 2023

Pharmacotherapy

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Intravenous β‐lactam antibiotics remain a cornerstone in the management of bacterial infections due to their broad spectrum of activity and excellent tolerability. β‐lactams are well established to display time‐dependent bactericidal activity, where reductions in bacterial burden are directly associated with the time that free drug concentrations remain above the minimum inhibitory concentration (MIC) of the pathogen during the dosing interval. In an effort to take advantage of these bactericidal characteristics, prolonged (extended and continuous) infusions (PIs) can be applied during the administration of intravenous β‐lactams to increase time above the MIC. PI dosing regimens have been implemented worldwide, but implementation is inconsistent. We report consensus therapeutic recommendations for the use of PI β‐lactams developed by an expert international panel with representation from clinical pharmacy and medicine. This consensus guideline provides recommendations regarding pharmacokinetic and pharmacodynamic targets, therapeutic drug‐monitoring considerations, and the use of PI β‐lactam therapy in the following patient populations: severely ill and nonseverely ill adult patients, pediatric patients, and obese patients. These recommendations provide the first consensus guidance for the use of β‐lactam therapy administered as PIs and have been reviewed and endorsed by the American College of Clinical Pharmacy (ACCP), the British Society for Antimicrobial Chemotherapy (BSAC), the Cystic Fibrosis Foundation (CFF), the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), the Infectious Diseases Society of America (IDSA), the Society of Critical Care Medicine (SCCM), and the Society of Infectious Diseases Pharmacists (SIDP).

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Continuous vs. intermittent cefotaxime administration in patients with chronic obstructive pulmonary disease and respiratory tract infections: pharmacokinetics/pharmacodynamics, bacterial susceptibility and clinical efficacy

Cited by 53 publications

References 24 publications

Optimizing beta-lactam antibiotic dosing in critically ill patients: Prolonged infusion versus intermittent bolus administration

Optimizing beta-lactam antibiotic dosing in critically ill patients: Prolonged infusion versus intermittent bolus administration

Continuous versus intermittent infusions of antibiotics for the treatment of severe acute infections

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