Extended Infusion of Beta-Lactams and Glycopeptides: A New Era in Pediatric Care? A Systematic Review and Meta-Analysis

Optimizing antibiotic therapy is imperative with rising bacterial resistance and high infection mortality. Extended infusion defined as a continuous infusion (COI) or prolonged infusion (PI) of beta-lactams and glycopeptides might improve efficacy and safety compared to their intermittent administra...

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Bibliographic Details
Published in:Antibiotics (Basel) 2024-02, Vol.13 (2), p.164
Main Authors: Burch, Andrea Rahel, von Arx, Lukas, Hasse, Barbara, Neumeier, Vera
Format: Article
Language:English
Subjects:
antibiotic
Antibiotics
Bacterial infections
beta-lactam
Bias
Cefepime
Children
Clinical outcomes
continuous infusion
Drug dosages
Drug resistance
Drug resistance in microorganisms
Effectiveness
Eradication
Glycopeptides
Health aspects
Infection
Infections
Medical care
Meropenem
Meta-analysis
Mortality
Pathogens
Patients
Pediatrics
Pharmacodynamics
Pharmacokinetics
Piperacillin
Quality management
Safety
Side effects
Success
Systematic review
Tazobactam
Tetracycline
Tetracyclines
β-Lactam antibiotics
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Summary:Optimizing antibiotic therapy is imperative with rising bacterial resistance and high infection mortality. Extended infusion defined as a continuous infusion (COI) or prolonged infusion (PI) of beta-lactams and glycopeptides might improve efficacy and safety compared to their intermittent administration (IA). This study aimed to evaluate the efficacy and safety of extended infusion in pediatric patients. Adhering to Cochrane standards, we conducted a systematic review with meta-analysis investigating the efficacy and safety of COI (24 h/d) and PI (>1 h/dose) compared to IA (≤1 h/dose) of beta-lactams and glycopeptides in pediatrics. Primary outcomes included mortality, clinical success, and microbiological eradication. Five studies could be included for the outcome mortality, investigating meropenem, piperacillin/tazobactam, cefepime, or combinations of these. The pooled relative risk estimate was 0.48 (95% CI 0.26-0.89, = 0.02). No significant differences between the administration modes were found for the outcomes of clinical success, microbiological eradication (beta-lactams; glycopeptides), and mortality (glycopeptides). No study reported additional safety issues, e.g., adverse drug reactions when using COI/PI vs. IA. Our findings suggest that the administration of beta-lactams by extended infusion leads to a reduction in mortality for pediatric patients.
ISSN:2079-6382
2079-6382
DOI:10.3390/antibiotics13020164