Continuous infusion of β-lactam antibiotics in severe infections: a review of its role

Abstract Continuous infusion of β-lactam antibiotics has been widely promoted to optimise their time-dependent activity. Increasing evidence is emerging suggesting potential benefits in patient populations with altered pathophysiology, such as seriously ill patients. From a pharmacokinetic viewpoint...

Full description

Saved in:
Bibliographic Details
Published in:International journal of antimicrobial agents 2007-07, Vol.30 (1), p.11-18
Main Authors: Roberts, Jason A, Paratz, Jennifer, Paratz, Elizabeth, Krueger, Wolfgang A, Lipman, Jeffrey
Format: Article
Language:English
Subjects:
Anti-Bacterial Agents - administration & dosage
Anti-Bacterial Agents - pharmacokinetics
Anti-Bacterial Agents - therapeutic use
Antibiotic
Antibiotics. Antiinfectious agents. Antiparasitic agents
Bacterial diseases
Bacterial Infections - drug therapy
Bacterial sepsis
beta-Lactams - administration & dosage
beta-Lactams - pharmacokinetics
beta-Lactams - therapeutic use
Biological and medical sciences
Clinical efficacy
Continuous infusion
Human bacterial diseases
Humans
Infectious Disease
Infectious diseases
Infusions, Intravenous
Medical sciences
Pharmacodynamics
Pharmacology. Drug treatments
Sepsis
β-Lactam
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Abstract Continuous infusion of β-lactam antibiotics has been widely promoted to optimise their time-dependent activity. Increasing evidence is emerging suggesting potential benefits in patient populations with altered pathophysiology, such as seriously ill patients. From a pharmacokinetic viewpoint, much information supports higher trough concentrations of β-lactam antibiotics when administered by continuous infusion. This advantage of continuous infusion translates into a superior ability to achieve pharmacodynamic targets, particularly when the minimum inhibitory concentration (MIC) of the pathogen is ≥4 mg/L. One drawback of continuous infusion may be limited physicochemical stability. This issue exists particularly for carbapenem antibiotics whereby prolonged infusions (i.e. >3 h) can be used to improve the time above the MIC compared with conventional bolus dosing. Few studies have examined clinical outcomes of bolus and continuous dosing of β-lactam antibiotics in seriously ill patients. No statistically significant differences have been shown for: mortality; time to normalisation of leukocytosis or pyrexia; or duration of mechanical ventilation, intensive care unit stay or hospital stay. Some evidence suggests improved clinical cure and resolution of illness with continuous infusion in seriously ill patients. Pharmacoeconomic advantages of continuous infusion of β-lactam antibiotics are well characterised. Available data suggest that seriously ill patients with severe infections requiring significant antibiotic courses (≥4 days) may be the subgroup that will achieve better outcomes with continuous infusion.
ISSN:0924-8579
1872-7913
DOI:10.1016/j.ijantimicag.2007.02.002