A systematic review on clinical benefits of continuous administration of [beta]-lactam antibiotics

Roberts, Jason A., Webb, Steven, Paterson, David, Ho, Kwok M. and Lipman, Jeffrey (2009) A systematic review on clinical benefits of continuous administration of [beta]-lactam antibiotics. Critical Care Medicine, 37 6: 2071-2078. doi:10.1097/CCM.0b013e3181a0054d


Author Roberts, Jason A.
Webb, Steven
Paterson, David
Ho, Kwok M.
Lipman, Jeffrey
Title A systematic review on clinical benefits of continuous administration of [beta]-lactam antibiotics
Formatted title
A systematic review on clinical benefits of continuous administration of β-lactam antibiotics
Journal name Critical Care Medicine   Check publisher's open access policy
ISSN 0090-3493
1530-0293
Publication date 2009-06
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1097/CCM.0b013e3181a0054d
Volume 37
Issue 6
Start page 2071
End page 2078
Total pages 8
Place of publication Baltimore, MD, United States
Publisher Lippincott Williams & Wilkins
Language eng
Formatted abstract
Objective: The clinical benefits of extended infusion or continuous infusion of β-lactam antibiotics remain controversial. We systematically reviewed the literature to determine whether any clinical benefits exist for administration of β-lactam antibiotics by extended or continuous infusion.
Data source: PubMed (January 1950 to November 2007), EMBASE (1966 to November 2007), and the Cochrane Controlled Trial Register were searched (updated November 2007). Study selections: Randomized controlled trials (RCTs) were meta-analyzed, and observational studies were described by two unblinded reviewers.
Data extraction: A total of 846 patients from eligible prospective randomized controlled studies were included in the meta-analysis. Two observational studies were deemed appropriate for description.
Data synthesis: A meta-analysis of prospective RCTs was undertaken using Review Manager. Among a total of 59 potentially relevant studies, 14 RCTs involving a total of 846 patients from nine countries were deemed appropriate for meta-analysis. The use of continuous infusion of a β-lactam antibiotic was not associated with an improvement in clinical cure (n = 755 patients; odds ratio: 1.04, 95% confidence interval: 0.74-1.46, p = 0.83, I2 = 0%) or mortality (n = 541 patients; odds ratio: 1.00, 95% confidence interval: 0.48-2.06, p = 1.00, I2 = 14.8%). All RCTs except one used a higher antibiotic dose in the bolus administration group. Two observational studies, not pooled because they did not meet the a priori criteria for meta-analysis, showed that β-lactam administration by extended or continuous infusion was associated with an improvement in clinical cure. The difference in the results between the meta-analysis results and the observational studies could be explained by the bias created by a higher dose of antibiotic in the bolus group in the RCTs and because many of the RCTs only recruited patients with a low acuity of illness.
Conclusions: The limited data available suggest that continuous infusion of β-lactam antibiotics leads to the same clinical results as higher dosed bolus administration in hospitalized patients.
Keyword β-Lactam antibiotic
Continuous infusion
Extended infusion
Bolus dosing
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Excellence in Research Australia (ERA) - Collection
UQ Centre for Clinical Research Publications
ERA 2012 Admin Only
School of Medicine Publications
 
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Created: Fri, 19 Feb 2010, 09:12:07 EST by Ms Laura Mctaggart on behalf of School of Medicine