Continuous vs thrice-daily ceftazidime for elective intravenous antipseudomonal therapy in cystic fibrosis

Riethmueller, J.; Junge, S.; Schroeter, T. W.; Kuemmerer, K.; Franke, P.; Ballmann, Manfred; Claass, Andreas; Broemme, S.; Jeschke, R; Hebestreit, Alexandra; Staab, Doris; Koetz, Karsten; Doering, G.; Stern, Martin

doi:10.1007/s15010-009-8116-5

Cited by 42 publications

(29 citation statements)

References 22 publications

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“…Giving the same daily dose as a short-term infusion q6h instead of q8h achieved only a PK-PD MIC breakpoint of 2 mg/liter in CF patients. This prediction is in excellent agreement with the better outcome for CF patients with resistant or intermediate isolates when they received continuous ceftazidime infusion compared to when they received short-term infusion (both coadministered with tobramycin) (36,63) and with results from in vitro PD models (1,20,51).…”

Section: Discussionsupporting

confidence: 64%

Population Pharmacokinetic Comparison and Pharmacodynamic Breakpoints of Ceftazidime in Cystic Fibrosis Patients and Healthy Volunteers

Bulitta

Landersdorfer

Hüttner

et al. 2010

Antimicrob Agents Chemother

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Despite the promising activity of ceftazidime against Pseudomonas aeruginosa and Burkholderia cepacia, there has not yet been a study that directly compared the pharmacokinetics (PK) of ceftazidime in cystic fibrosis (CF) patients and healthy volunteers by population PK methodology. We assessed the population PK and PK/pharmacodynamic (PD) breakpoints of ceftazidime in CF patients and healthy volunteers.

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Section: Discussionsupporting

confidence: 64%

Population Pharmacokinetic Comparison and Pharmacodynamic Breakpoints of Ceftazidime in Cystic Fibrosis Patients and Healthy Volunteers

Bulitta

Landersdorfer

Hüttner

et al. 2010

Antimicrob Agents Chemother

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“…Riethmueller et al, found a decrease in WCC favouring CI of ceftazidime in cystic fibrosis patients [364]. However, the differences obtained in the randomized crossover study were insignificant when compared to IB (CI; -2216 versus IB; 2209, p = 0.98).…”

Section: Mortalitymentioning

confidence: 91%

“…Riethmueller et al, compared anti-infectious properties of CI and thrice-daily administration of ceftazidime in 56 cystic fibrosis patients in a randomized crossover study [364]. The authors found no significant difference between the two methods in terms of decrease in leukocyte counts, clinical, lung function and inflammatory parameters.…”

Section: Mortalitymentioning

confidence: 99%

“…Several studies, mostly in critically ill patients, have sought to evaluate the mortality outcome produced by beta-lactams administered via CI or IB (Table 5- The clinical utility of CI and IB in cystic fibrosis have been compared in several studies [364][365][366].…”

Section: Mortalitymentioning

confidence: 99%

“…Whilst the data that describes the effect of CI on length of stay, data from studies which examined Several studies (Table 3-3) have compared adverse events from CI and bolus administration of betalactams, although no significant differences are evident [193,256,[363][364][365]375]. Interestingly, some studies have reported no adverse events [193,363,364] while others have made multiple identifications [256,365,375].…”

Section: Mechanical Ventilationmentioning

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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Home versus hospital intravenous antibiotic therapy for cystic fibrosis

Balaguer

Dios

2012

Cochrane Database of Systematic Reviews

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Continuous vs thrice-daily ceftazidime for elective intravenous antipseudomonal therapy in cystic fibrosis

Abstract: We conclude that continuous or thrice-daily dosing of intravenous ceftazidime, both combined with once-daily tobramycin, are equally effective application regimens for elective antipseudomonal therapy in clinically stable patients with CF.

Cited by 42 publications

References 22 publications

Population Pharmacokinetic Comparison and Pharmacodynamic Breakpoints of Ceftazidime in Cystic Fibrosis Patients and Healthy Volunteers

Population Pharmacokinetic Comparison and Pharmacodynamic Breakpoints of Ceftazidime in Cystic Fibrosis Patients and Healthy Volunteers

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

Home versus hospital intravenous antibiotic therapy for cystic fibrosis

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