Prolonged infusion of beta-lactam antibiotics for Gram-negative infections: rationale and evidence base.

Abstract

PURPOSE OF REVIEW:

The aim of this review is to discuss the rationale of and current evidence for prolonged beta-lactam infusion in the management of Gram-negative infections.

RECENT FINDINGS:

Pharmacokinetic/pharmacodynamic (PK/PD) data from various in-vitro and in-vivo experimental studies conclusively support prolonged infusion over intermittent infusion in terms of achieving effective beta-lactam exposure for maximal bacterial killing. Superior PK/PD target attainment has been demonstrated with prolonged beta-lactam infusion in patient populations that are more likely to have less susceptible Gram-negative infections. These populations include critically ill patients, cystic fibrosis patients and patients with malignant diseases. The clinical impact of prolonged beta-lactam infusion is likely to be the greatest in these patient groups: critically ill patients with a high level of illness severity who are not receiving renal replacement therapy; patients with nonfermenting Gram-negative bacilli infection and patients with respiratory infection. Critically ill patients with augmented renal clearance may not achieve effective beta-lactam exposure even with the use of prolonged infusion. Maximizing the effectiveness of prolonged beta-lactam infusion via therapeutic drug monitoring is becoming a more common strategy in the management of critically ill patients with Gram-negative infection.

SUMMARY:

Prolonged beta-lactam infusion may not benefit all patients but only for those who are critically ill and/or immunocompromised, who are also more likely to have less susceptible Gram-negative infections.

• Authors: Mohd H Abdul-Aziz, Federica Portunato, Jason A Roberts
• Journal: Current opinion in infectious diseases (Curr Opin Infect Dis) Vol. 33 Issue 6 Pg. 501-510 (12 2020) ISSN: 1473-6527 [Electronic] United States
• PMID: 33009140 (Publication Type: Journal Article, Review)

Chemical References

• Anti-Bacterial Agents
• beta-Lactams

Topics

• Adult
• Aged
• Aged, 80 and over
• Anti-Bacterial Agents (administration & dosage, pharmacokinetics, pharmacology)
• Critical Illness (therapy)
• Cystic Fibrosis (drug therapy)
• Drug Monitoring (methods)
• Gram-Negative Bacteria (drug effects)
• Gram-Negative Bacterial Infections (drug therapy)
• Humans
• Immunocompromised Host
• Infusions, Intravenous
• Microbial Sensitivity Tests (methods)
• Middle Aged
• Respiratory Tract Infections (drug therapy, microbiology)
• Severity of Illness Index
• beta-Lactams (administration & dosage, pharmacokinetics, pharmacology)