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Continuous beta-lactam infusion in critically ill patients: the clinical evidence.

Abdul-Aziz MH, Dulhunty JM, Bellomo R, Lipman J, Roberts JA - Ann Intensive Care (2012)

Bottom Line: No significant difference between these two dosing strategies in terms of patient outcomes has been shown yet.This is despite compelling in vitro and in vivo pharmacokinetic/pharmacodynamic (PK/PD) data.A lack of significance in clinical outcome studies may be due to several methodological flaws potentially masking the benefits of continuous infusion observed in preclinical studies.

View Article: PubMed Central - HTML - PubMed

Affiliation: Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Australia. Joel_Dulhunty@health.qld.gov.au.

ABSTRACT
There is controversy over whether traditional intermittent bolus dosing or continuous infusion of beta-lactam antibiotics is preferable in critically ill patients. No significant difference between these two dosing strategies in terms of patient outcomes has been shown yet. This is despite compelling in vitro and in vivo pharmacokinetic/pharmacodynamic (PK/PD) data. A lack of significance in clinical outcome studies may be due to several methodological flaws potentially masking the benefits of continuous infusion observed in preclinical studies. In this review, we explore the methodological shortcomings of the published clinical studies and describe the criteria that should be considered for performing a definitive clinical trial. We found that most trials utilized inconsistent antibiotic doses and recruited only small numbers of heterogeneous patient groups. The results of these trials suggest that continuous infusion of beta-lactam antibiotics may have variable efficacy in different patient groups. Patients who may benefit from continuous infusion are critically ill patients with a high level of illness severity. Thus, future trials should test the potential clinical advantages of continuous infusion in this patient population. To further ascertain whether benefits of continuous infusion in critically ill patients do exist, a large-scale, prospective, multinational trial with a robust design is required.

No MeSH data available.


Related in: MedlinePlus

The summary of the current limitations and flaws associated with the available clinical trial.
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Figure 4: The summary of the current limitations and flaws associated with the available clinical trial.

Mentions: Since the initial availability of antibiotics, methods to optimize antibiotic dosing have been explored [17,73]. Numerous trials have been conducted with beta-lactams testing various dosing strategies in various patient populations [52,74-89]. The characteristics and findings of these relevant clinical trials are described in Tables 1 and 2, respectively. However, these studies have not defined whether altered dosing approaches are advantageous and which patient groups may benefit. Most of these trials were conducted in North America and Europe between 1979 and 2008 with all but two studies published after the year 2000 [88,89]. A number of articles also have discussed the potential advantages and disadvantages of CI [29,31,46,90,91]. Yet, the limitations of the existing studies have not been analyzed in detail and require further elaboration. Figure 4 briefly summarizes the current limitations associated with the available clinical trials.


Continuous beta-lactam infusion in critically ill patients: the clinical evidence.

Abdul-Aziz MH, Dulhunty JM, Bellomo R, Lipman J, Roberts JA - Ann Intensive Care (2012)

The summary of the current limitations and flaws associated with the available clinical trial.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3475088&req=5

Figure 4: The summary of the current limitations and flaws associated with the available clinical trial.
Mentions: Since the initial availability of antibiotics, methods to optimize antibiotic dosing have been explored [17,73]. Numerous trials have been conducted with beta-lactams testing various dosing strategies in various patient populations [52,74-89]. The characteristics and findings of these relevant clinical trials are described in Tables 1 and 2, respectively. However, these studies have not defined whether altered dosing approaches are advantageous and which patient groups may benefit. Most of these trials were conducted in North America and Europe between 1979 and 2008 with all but two studies published after the year 2000 [88,89]. A number of articles also have discussed the potential advantages and disadvantages of CI [29,31,46,90,91]. Yet, the limitations of the existing studies have not been analyzed in detail and require further elaboration. Figure 4 briefly summarizes the current limitations associated with the available clinical trials.

Bottom Line: No significant difference between these two dosing strategies in terms of patient outcomes has been shown yet.This is despite compelling in vitro and in vivo pharmacokinetic/pharmacodynamic (PK/PD) data.A lack of significance in clinical outcome studies may be due to several methodological flaws potentially masking the benefits of continuous infusion observed in preclinical studies.

View Article: PubMed Central - HTML - PubMed

Affiliation: Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Australia. Joel_Dulhunty@health.qld.gov.au.

ABSTRACT
There is controversy over whether traditional intermittent bolus dosing or continuous infusion of beta-lactam antibiotics is preferable in critically ill patients. No significant difference between these two dosing strategies in terms of patient outcomes has been shown yet. This is despite compelling in vitro and in vivo pharmacokinetic/pharmacodynamic (PK/PD) data. A lack of significance in clinical outcome studies may be due to several methodological flaws potentially masking the benefits of continuous infusion observed in preclinical studies. In this review, we explore the methodological shortcomings of the published clinical studies and describe the criteria that should be considered for performing a definitive clinical trial. We found that most trials utilized inconsistent antibiotic doses and recruited only small numbers of heterogeneous patient groups. The results of these trials suggest that continuous infusion of beta-lactam antibiotics may have variable efficacy in different patient groups. Patients who may benefit from continuous infusion are critically ill patients with a high level of illness severity. Thus, future trials should test the potential clinical advantages of continuous infusion in this patient population. To further ascertain whether benefits of continuous infusion in critically ill patients do exist, a large-scale, prospective, multinational trial with a robust design is required.

No MeSH data available.


Related in: MedlinePlus