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

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 compellin...

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Main Authors:	Abdul Aziz, Mohd. Hafiz, Dulhunty, Joel M., Bellomo, Rinaldo, Lipman, Jeffrey, Roberts, Jason A.
Format:	Article
Language:	English
Published:	Springer-Verlag Berlin Heidelberg 2012
Subjects:	R Medicine (General) RM Therapeutics. Pharmacology RS Pharmacy and materia medica
Online Access:	http://irep.iium.edu.my/30503/ http://irep.iium.edu.my/30503/ http://irep.iium.edu.my/30503/ http://irep.iium.edu.my/30503/2/2110-5820-2-37.pdf

id	iium-30503
recordtype	eprints
spelling	iium-305032013-07-16T01:44:39Z http://irep.iium.edu.my/30503/ Continuous beta-lactam infusion in critically ill patients: the clinical evidence Abdul Aziz, Mohd. Hafiz Dulhunty, Joel M. Bellomo, Rinaldo Lipman, Jeffrey Roberts, Jason A. R Medicine (General) RM Therapeutics. Pharmacology RS Pharmacy and materia medica 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. Springer-Verlag Berlin Heidelberg 2012-08 Article PeerReviewed application/pdf en http://irep.iium.edu.my/30503/2/2110-5820-2-37.pdf Abdul Aziz, Mohd. Hafiz and Dulhunty, Joel M. and Bellomo, Rinaldo and Lipman, Jeffrey and Roberts, Jason A. (2012) Continuous beta-lactam infusion in critically ill patients: the clinical evidence. Annals of Intensive Care, 2 (37). pp. 1-16. ISSN 2110-5820 http://link.springer.com/article/10.1186%2F2110-5820-2-37 10.1186/2110-5820-2-37
repository_type	Digital Repository
institution_category	Local University
institution	International Islamic University Malaysia
building	IIUM Repository
collection	Online Access
language	English
topic	R Medicine (General) RM Therapeutics. Pharmacology RS Pharmacy and materia medica
spellingShingle	R Medicine (General) RM Therapeutics. Pharmacology RS Pharmacy and materia medica Abdul Aziz, Mohd. Hafiz Dulhunty, Joel M. Bellomo, Rinaldo Lipman, Jeffrey Roberts, Jason A. Continuous beta-lactam infusion in critically ill patients: the clinical evidence
description	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.
format	Article
author	Abdul Aziz, Mohd. Hafiz Dulhunty, Joel M. Bellomo, Rinaldo Lipman, Jeffrey Roberts, Jason A.
author_facet	Abdul Aziz, Mohd. Hafiz Dulhunty, Joel M. Bellomo, Rinaldo Lipman, Jeffrey Roberts, Jason A.
author_sort	Abdul Aziz, Mohd. Hafiz
title	Continuous beta-lactam infusion in critically ill patients: the clinical evidence
title_short	Continuous beta-lactam infusion in critically ill patients: the clinical evidence
title_full	Continuous beta-lactam infusion in critically ill patients: the clinical evidence
title_fullStr	Continuous beta-lactam infusion in critically ill patients: the clinical evidence
title_full_unstemmed	Continuous beta-lactam infusion in critically ill patients: the clinical evidence
title_sort	continuous beta-lactam infusion in critically ill patients: the clinical evidence
publisher	Springer-Verlag Berlin Heidelberg
publishDate	2012
url	http://irep.iium.edu.my/30503/ http://irep.iium.edu.my/30503/ http://irep.iium.edu.my/30503/ http://irep.iium.edu.my/30503/2/2110-5820-2-37.pdf
first_indexed	2023-09-18T20:44:39Z
last_indexed	2023-09-18T20:44:39Z
_version_	1777409594127024128

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

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