Intérêt pharmacodynamique de la perfusion continue vs l'administration intermittente de ceftazidime dans les pneumonies nosocomiales sévères

Cousson, J.; Floch, Thierry; Vernet-Garnier, Véronique; Appriou, M.; Petit, J; Lamiable, Denis; Hoizey, Guillaume

doi:10.1016/j.patbio.2005.06.002

Cited by 17 publications

(6 citation statements)

References 8 publications

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“…Of the 25 RCTs evaluating mortality, 18 studies utilized a loading dose and demonstrated no survival benefit with an RR of 0.90 (95% confidence interval 0.74 to 1.10), I 2 = 0% and similar results observed among severely ill and nonseverely ill patients (Figures S10-S12). 49,97,98,[100][101][102]104,105,107,108,110,114,[116][117][118]132,133,156 Given a loading dose was administered prior to initiation of CI β-lactam dosing in all except one RCT 99 and in three out of nine studies that utilized EI, 107,116,118 it would be prudent to utilize loading doses until further studies can clarify the implications of this practice.…”

Section: Evidence Summarymentioning

confidence: 99%

“…In studies with CI, the maintenance dose was initiated immediately after the completion of the loading dose . 49,97,98,[100][101][102]104,105,108,110,114,117,132,133,156 In two of the three studies using EI, the first maintenance dose corresponded with the dosing interval of either every 6 or 8 h. 107,118 The other study utilized an every 8-h maintenance dose that was initiated 6 h after the loading dose. 116…”

Section: Evidence Summarymentioning

confidence: 99%

“…This study only included 21 patients with suspected sepsis, resulting in a wide confidence interval, limited external validity, and mortality was not the primary outcome. Collectively, the mortality rate across all RCTs was numerically lower with prolonged administration methods, but the difference was not statistically significant (RR 0.86 [95% confidence interval 0.72 to 1.02; I 2 = 0]) 49,97‐115 (Figure S1). CI was used in 13 studies, whereas EI was used in the remaining 7 studies.…”

Section: Consensus Statements and Recommendationsmentioning

confidence: 99%

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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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Section: Evidence Summarymentioning

confidence: 99%

Section: Evidence Summarymentioning

confidence: 99%

Section: Consensus Statements and Recommendationsmentioning

confidence: 99%

See 1 more Smart Citation

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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“…The majority of studies were excluded during initial screening because they were Monte Carlo simulation studies that did not involve patients, or were studies that did not involve PDD. The 48 studies were excluded after full review for the following reasons: lack of control group or clinical outcomes [38-64], not discussing pharmacodynamic-based dosing [65-74], Monte Carlo simulations or mathematical modeling [75-81], duplicate publications [82,83], and review articles [84,85]. …”

Section: Resultsmentioning

confidence: 99%

Optimal dosing of antibiotics in critically ill patients by using continuous/extended infusions: a systematic review and meta-analysis

2013

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IntroductionThe aim of this study was to determine whether using pharmacodynamic-based dosing of antimicrobials, such as extended/continuous infusions, in critically ill patients is associated with improved outcomes as compared with traditional dosing methods.MethodsWe searched Medline, HealthStar, EMBASE, Cochrane Clinical Trial Registry, and CINAHL from inception to September 2013 without language restrictions for studies comparing the use of extended/continuous infusions with traditional dosing. Two authors independently selected studies, extracted data on methodology and outcomes, and performed quality assessment. Meta-analyses were performed by using random-effects models.ResultsOf 1,319 citations, 13 randomized controlled trials (RCTs) (n = 782 patients) and 13 cohort studies (n = 2,117 patients) met the inclusion criteria. Compared with traditional non-pharmacodynamic-based dosing, RCTs of continuous/extended infusions significantly reduced clinical failure rates (relative risk (RR) 0.68; 95% confidence interval (CI) 0.49 to 0.94, P = 0.02) and intensive care unit length of stay (mean difference, −1.5; 95% CI, −2.8 to −0.2 days, P = 0.02), but not mortality (RR, 0.87; 95% CI, 0.64 to 1.19; P = 0.38). No significant between-trial heterogeneity was found for these analyses (I2 = 0). Reduced mortality rates almost achieved statistical significance when the results of all included studies (RCTs and cohort studies) were pooled (RR, 0.83; 95% CI, 0.69 to 1.00; P = 0.054).ConclusionsPooled results from small RCTs suggest reduced clinical failure rates and intensive care unit length-of-stay when using continuous/extended infusions of antibiotics in critically ill patients. Reduced mortality rates almost achieved statistical significance when the results of RCTs were combined with cohort studies. These results support the conduct of adequately powered RCTs to define better the utility of continuous/extended infusions in the era of antibiotic resistance.

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“…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%

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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Intérêt pharmacodynamique de la perfusion continue vs l'administration intermittente de ceftazidime dans les pneumonies nosocomiales sévères

Cited by 17 publications

References 8 publications

Optimal dosing of antibiotics in critically ill patients by using continuous/extended infusions: a systematic review and meta-analysis

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

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