Continuous infusion vs. bolus dosing: Implications for beta-lactam antibiotics

Abdul-Aziz, Mohd Hafiz, Staatz, C. E., Kirkpatrick, C. M. J., Lipman, J. and Roberts, J. A. (2012) Continuous infusion vs. bolus dosing: Implications for beta-lactam antibiotics. Minerva Anestesiologica, 78 1: 94-104.

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Author Abdul-Aziz, Mohd Hafiz
Staatz, C. E.
Kirkpatrick, C. M. J.
Lipman, J.
Roberts, J. A.
Title Continuous infusion vs. bolus dosing: Implications for beta-lactam antibiotics
Formatted title
Continuous infusion vs. bolus dosing: Implications for beta-lactam antibiotics
Journal name Minerva Anestesiologica   Check publisher's open access policy
ISSN 0375-9393
1827-1596
Publication date 2012-01-01
Year available 2011
Sub-type Critical review of research, literature review, critical commentary
Open Access Status Not yet assessed
Volume 78
Issue 1
Start page 94
End page 104
Total pages 11
Place of publication Turin, Italy
Publisher Edizioni Minerva Medica
Language eng
Subject 2703 Anesthesiology and Pain Medicine
Abstract Beta-lactam antibiotics display time-dependant pharmacodynamics whereby constant antibiotic concentrations rather than high peak concentrations are most likely to result in effective treatment of infections caused by susceptible bacteria. Continuous administration has been suggested as an alternative strategy, to conventional intermittent dosing, to optimise beta-lactam pharmacokinetic/pharmacodynamic (PK/PD) properties. With the availability of emerging data, we elected to systematically investigate the published literature describing the comparative PK/PD and clinical outcomes of beta-lactam antibiotics administered by continuous or intermittent infusion. We found that the studies have been performed in various patient populations including critically ill, cancer and cystic fibrosis patients. Available in vitro PK/PD data conclusively support the administration of beta-lactams via continuous infusion for maximizing bacterial killing from consistent attainment of pharmacodynamic end-points. In addition, clinical outcome data supports equivalence, even with the use of a lower dose by continuous infusion. However, the present clinical data is limited with small sample sizes common with insufficient power to detect advantages in favour of either dosing strategy. With abundant positive pre-clinical data as well as document in vivo PK/PD advantages, large multi-centre trials are needed to describe whether continuous administration of beta-lactams is truly more effective than intermittent dosing. (Minerva Anestesiol 2012;78:94-104)
Formatted abstract
Beta-lactam antibiotics display time-dependant pharmacodynamics whereby constant antibiotic concentrations rather than high peak concentrations are most likely to result in effective treatment of infections caused by susceptible bacteria. Continuous administration has been suggested as an alternative strategy, to conventional intermittent dosing, to optimise beta-lactam pharmacokinetic/pharmacodynamic (PK/PD) properties. With the availability of emerging data, we elected to systematically investigate the published literature describing the comparative PK/PD and clinical outcomes of beta-lactam antibiotics administered by continuous or intermittent infusion. We found that the studies have been performed in various patient populations including critically ill, cancer and cystic fibrosis patients. Available in vitro PK/PD data conclusively support the administration of beta-lactams via continuous infusion for maximizing bacterial killing from consistent attainment of pharmacodynamic end-points. In addition, clinical outcome data supports equivalence, even with the use of a lower dose by continuous infusion. However, the present clinical data is limited with small sample sizes common with insufficient power to detect advantages in favour of either dosing strategy. With abundant positive pre-clinical data as well as document in vivo PK/PD advantages, large multi-centre trials are needed to describe whether continuous administration of beta-lactams is truly more effective than intermittent dosing.
Keyword Monbactams
Treatment outcome
Infusion pumps
Pharmacology
Pharmacokinetics
Q-Index Code C1
Q-Index Status Confirmed Code
Grant ID 519702
06/037
569917
Institutional Status UQ
Additional Notes EPUB Ahead Of Print 16 June 2011 (incorrectly cites publication as Vol.7 No.4, p1-11).

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2012 Collection
School of Medicine Publications
School of Pharmacy Publications
 
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Created: Fri, 23 Dec 2011, 02:06:07 EST by Sia Athanasas on behalf of Anaesthesiology and Critical Care - RBWH