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Continuous Infusion Versus Intermittent Bolus of Beta-Lactams in Critically Ill Patients with Respiratory Infections: A Systematic Review and Meta-analysis

European Journal of Drug Metabolism and Pharmacokinetics volume 43, pages 155–170 (2018)Cite this article

A Correction to this article was published on 07 November 2017

This article has been updated

Abstract

Background

Critically ill patients display altered pharmacokinetics and pharmacodynamics and are more likely to be infected with more resistant pathogens. Beta-lactam antibiotics exhibit time-dependent pharmacodynamics; therefore, it is postulated that continuous infusion (CI) may optimize these parameters.

Objective

To perform a systematic review and meta-analysis of the available literature comparing CI versus intermittent bolus (IB) of beta-lactam antibiotics in critically ill adult patients with respiratory infections to determine if clinical benefits exist.

Methods

PubMed, EMBASE, and Web of Science were searched. Thirteen randomized controlled trials were included in the meta-analyses of clinical cure and/or mortality. Four retrospective studies reporting clinical cure and/or mortality, and 11 studies that reported pharmacokinetic/pharmacodynamic parameters were included in the systematic review.

Results

The majority of patients in both groups maintained the percentage of time the free drug concentration exceeded the minimum inhibitory concentration (%fT > MIC) targets throughout the treatment, with differences favoring CI being more prevalent when the MIC of the offending pathogen increased. CI of beta-lactam antibiotics in critically ill adult patients with respiratory infections significantly improved clinical cure rates when compared to IB (risk ratio [RR] 1.177; 95% CI 1.065–1.300). No significant differences in mortality rates were seen when patients were treated with either dosing modality (RR 0.845; 95% CI 0.644–1.108).

Conclusions

CI of beta-lactam antibiotics is associated with better cure rates and higher %fT > MIC when administered to critically ill patients with respiratory infections, but may be most beneficial in severely ill patients with more resistant Gram-negative bacterial infections.

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Change history

  • 07 November 2017

    Unfortunately, ≥ was found missing between scores and 20 in conclusion section of the online published article. The original article was corrected.

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Acknowledgements

Authors would like to thank Peggy Edwards, Reference Librarian and Unit Manager at the Preston Smith Library at the Texas Tech University Health Sciences Center for her assistance with the literature search and search strategy information. Authors would also like to thank Dr. Irene La-Beck, Associate Professor at the Texas Tech University Health Sciences Center School of Pharmacy for her advice on the meta-analysis.

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Authors and Affiliations

  1. Department of Pharmacy Practice, Texas Tech University Health Sciences Center School of Pharmacy, 1718 Pine Street, Abilene, TX, 79601, USA

    Young R. Lee, Pamela D. Miller, Jackson D. Hager & Kailey S. Kuntz

  2. Gulfstream Genomics, LLC, 9301 N Central Expressway STE 335, Dallas, TX, 75231, USA

    Saeed K. Alzghari

  3. Tampa General Hospital, 1 Tampa General Circle, Tampa, FL, 33606, USA

    Delilah D. Blanco

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Author Young Lee, author Pamela Miller, author Saeed Alzghari, author Delilah Blanco, author Kailey Kuntz, and author Jackson Hager declare that they have no conflict of interest.

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Additional information

The original version of this article was revised: ≥ was found missing between scores and 20 in the conclusion section of the online published article.

A correction to this article is available online at https://doi.org/10.1007/s13318-017-0446-6.

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Lee, Y.R., Miller, P.D., Alzghari, S.K. et al. Continuous Infusion Versus Intermittent Bolus of Beta-Lactams in Critically Ill Patients with Respiratory Infections: A Systematic Review and Meta-analysis. Eur J Drug Metab Pharmacokinet 43, 155–170 (2018). https://doi.org/10.1007/s13318-017-0439-5

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