Prolonged infusion versus intermittent boluses of β-lactam antibiotics for treatment of acute infections: a meta-analysis

Teo, Jin Yao; Liew, Yi Xin; Lee, Winnie; Kwa, Andrea Lay-Hoon

doi:10.1016/j.ijantimicag.2014.01.027

Cited by 79 publications

(54 citation statements)

References 55 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The clinical benefits of the continuous infusion strategy are supported by the results of recent meta-analyses, especially for patients with a high sickness severity and infected by less-susceptible pathogens, such as nonfermenting Gram-negative bacilli (11)(12)(13). In our cohort, the infective organism was not identified for 19 of the 53 patients (35.8%).…”

supporting

confidence: 66%

Neurotoxic Concentration of Piperacillin during Continuous Infusion in Critically Ill Patients

Quinton

Bodeau

Kontar

et al. 2017

Antimicrob Agents Chemother

View full text Add to dashboard Cite

This retrospective cohort study included 53 patients admitted to the intensive care unit (ICU), with an average age of 69 years, without neurologic disorder before initiation of a continuous piperacillin infusion at the standard dose and who underwent piperacillin serum concentration monitoring. Among them, 23 developed a neurologic disorder for which the piperacillin causality was chronologically and semiologically suggestive. A concentration threshold of 157.2 mg/liter independently predicted neurotoxicity with 96.7% specificity and 52.2% sensitivity and may constitute a limitation when targeting less susceptible pathogens.

show abstract

supporting

confidence: 66%

Neurotoxic Concentration of Piperacillin during Continuous Infusion in Critically Ill Patients

Quinton

Bodeau

Kontar

et al. 2017

Antimicrob Agents Chemother

View full text Add to dashboard Cite

show abstract

“…For example, Benko et al (7) time during which the serum concentration of ceftazidime remained above the threshold of 20 mg/liter (TϾ20 mg). Several other authors have reported similar findings (9)(10)(11)(12)(13). Contrary to the observations of Benko et al (7), the median AUC over 48 h did not differ significantly between modes of administration in our study.…”

Section: Discussionsupporting

confidence: 62%

Lung Concentrations of Ceftazidime Administered by Continuous versus Intermittent Infusion in Patients with Ventilator-Associated Pneumonia

Cousson

Floch²,

Guillard

et al. 2015

Antimicrob Agents Chemother

View full text Add to dashboard Cite

e Ceftazidime is a beta-lactam compound that exerts a time-dependent bactericidal effect. Numerous arguments are in favor of continuous administration of ceftazidime, both for reasons of clinical efficacy and to preserve bacteriological mutation. We report a prospective, single-center, parallel-group, randomized, controlled trial comparing two modes of administration of ceftazidime, namely, continuous administration (loading dose of 20 mg/kg of body weight followed by 60 mg/kg/day) versus intermittent administration (20 mg/kg over 30 min every 8 h) in 34 patients with ventilator-associated pneumonia due to Gram-negative bacilli. The study was performed over 48 h with 13 and 18 assessments of serum ceftazidime in the continuous-infusion group (group A) and the intermittent-fusion group (group B), respectively. Bronchoalveolar lavage (BAL) was performed at steady state in both groups at 44 h to determine ceftazidime levels in the epithelial lining fluid. We chose a predefined threshold of 20 mg/liter for serum concentrations of ceftazidime because of ecological conditions in our center. The median time above 20 mg/ liter (T>20 mg) was 100% in group A versus 46% in group B. In group A, 14/17 patients had 100% T>20 mg, versus only 1/17 patients in group B. In the epithelial lining fluid, the median concentration of ceftazidime was 12 mg/liter in group A versus 6 mg/liter in group B. A threshold of 8 mg/liter in the epithelial lining fluid was achieved twice as often in group A as in group B. This study of ceftazidime concentrations in the epithelial lining fluid indicates that continuous infusion presents advantages in terms of pharmacodynamics and predictable efficacy in patients presenting ventilator-associated pneumonia. Ceftazidime is a third-generation cephalosporin that is frequently used in the treatment of ventilator-associated pneumonia (VAP) because of its efficacy against Pseudomonas aeruginosa. Ceftazidime is a beta-lactam compound that exerts a time-dependent bactericidal effect. The pharmacodynamic property that predicts better clinical efficacy in vitro is the time during which the tissue concentration of the antibiotic is greater than the MIC of the organism (1, 2). Critically ill patients with severe sepsis present wide intra-and interindividual variations in volume of distribution, thus altering the pharmacokinetics of the antibiotic (2-4). A number of elements plead in favor of continuous administration of ceftazidime, both for reasons of clinical efficacy and to preserve bacteriological mutation (2, 5). In view of local ecological conditions in our center (MIC of ceftazidime for Pseudomonas aeruginosa of Ͻ4 mg/liter), we aimed to achieve a minimum serum concentration of 20 mg/liter.The primary objective of this study was to show that continuous infusion of ceftazidime is superior to intermittent infusion, as assessed by the concentration of ceftazidime in the epithelial lining fluid (ELF), in patients with VAP due to Gram-negative bacilli. The secondary objective was to show that continuous infus...

show abstract

“…Although quite a few of these have been conducted over time, they differ markedly in their inclusion/exclusion criteria, thus not necessarily allowing elucidation of the true effectiveness of nontraditional beta-lactam dosing regimens (4,18,(88)(89)(90)(91)(92)(93)(94)(95)(96)(97)(98)(99)(100)(101)(102). Recent metaanalyses that focused on beta-lactams (Table 3) have mostly concluded that existing data were favorable for the use of specific or all beta-lactam agents by prolonged or continuous infusion in terms of clinical outcomes.…”

Section: Contemporary Studiesmentioning

confidence: 99%

Continuous and Prolonged Intravenous β-Lactam Dosing: Implications for the Clinical Laboratory

2016

View full text Add to dashboard Cite

SUMMARYBeta-lactam antibiotics serve as a cornerstone in the management of bacterial infections because of their wide spectrum of activity and low toxicity. Since resistance rates among bacteria are continuously on the rise and the pipeline for new antibiotics does not meet this trend, an optimization of current beta-lactam treatment is needed. This review provides an overview of optimization through use of prolonged- and continuous-infusion dosing strategies compared with more traditional intermittent infusions. Included is an overview of the scientific basis for using these nontraditional prolonged- and continuous-infusion-based regimens, with a focus on major areas in which the clinical laboratory can support the clinical use of these regimens.

show abstract

Prolonged infusion versus intermittent boluses of β-lactam antibiotics for treatment of acute infections: a meta-analysis

Cited by 79 publications

References 55 publications

Neurotoxic Concentration of Piperacillin during Continuous Infusion in Critically Ill Patients

Neurotoxic Concentration of Piperacillin during Continuous Infusion in Critically Ill Patients

Lung Concentrations of Ceftazidime Administered by Continuous versus Intermittent Infusion in Patients with Ventilator-Associated Pneumonia

Continuous and Prolonged Intravenous β-Lactam Dosing: Implications for the Clinical Laboratory

Contact Info

Product

Resources

About