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Prolonged infusion versus intermittent boluses of β-lactam antibiotics for treatment of acute infections: a meta-analysis
- Source :
- International journal of antimicrobial agents. 43(5)
- Publication Year :
- 2013
-
Abstract
- The clinical advantages of prolonged (extended/continuous) infusion remain controversial. Previous studies and reviews have failed to show consistent clinical benefits of extending the infusion time. This meta-analysis sought to determine whether prolonged β-lactam infusions were associated with a reduction in mortality and improvement in clinical success. A search of PubMed, EMBASE and The Cochrane Library for randomised controlled trials (RCTs) and observational studies comparing prolonged infusion with intermittent bolus administration of the same antibiotic in hospitalised adult patients was conducted. Primary outcomes evaluated were mortality and clinical success. A total of 29 studies with 2206 patients (18 RCTs and 11 observational studies) were included in the meta-analysis. Compared with intermittent boluses, use of prolonged infusion appeared to be associated with a significant reduction in mortality [pooled relative risk (RR) = 0.66, 95% confidence interval (CI) 0.53-0.83] and improvement in clinical success (RR = 1.12, 95% CI 1.03-1.21). Statistically significant benefit was supported by non-randomised studies (mortality, RR = 0.57, 95% CI 0.43-0.76; clinical success, RR = 1.34, 95% CI 1.02-1.76) but not by RCTs (mortality, RR = 0.83, 95% CI 0.57-1.21; clinical success, RR = 1.05, 95% CI 0.99-1.12). The positive results from observational studies, especially in the face of increasing antibiotic resistance, serve to justify the imperative need to conduct a large-scale, well-designed, multicentre RCT involving critically ill patients infected with high minimum inhibitory concentration pathogens to clearly substantiate this benefit.
- Subjects :
- Microbiology (medical)
medicine.medical_specialty
medicine.drug_class
Antibiotics
Cochrane Library
beta-Lactams
law.invention
Randomized controlled trial
law
Internal medicine
medicine
Humans
Pharmacology (medical)
Intensive care medicine
Randomized Controlled Trials as Topic
business.industry
General Medicine
Bacterial Infections
Survival Analysis
Confidence interval
Anti-Bacterial Agents
Infectious Diseases
Treatment Outcome
Relative risk
Meta-analysis
Intermittent bolus
Observational study
Administration, Intravenous
business
Subjects
Details
- ISSN :
- 18727913
- Volume :
- 43
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- International journal of antimicrobial agents
- Accession number :
- edsair.doi.dedup.....fa390e2823e6ce54cf4c00fed4da7065