Continuous versus intermittent intravenous administration of antibiotics: a meta-analysis of randomised controlled trials.
Intermittent intravenous administration of antibiotics is the first-line approach in the management of severe infections worldwide. However, the potential benefits of alternate modes of administration of antibiotics, including continuous intravenous infusion, deserve further evaluation. We did a meta-analysis of randomised controlled trials comparing continuous intravenous infusion with intermittent intravenous administration of the same antibiotic regimen. Nine randomised controlled trials studying beta-lactams, aminoglycosides, and vancomycin were included. Clinical failure was lower, although without statistical significance, in patients receiving continuous infusion of antibiotics (pooled OR 0.73, 95% CI 0.53-1.01); the difference was statistically significant in a subset of randomised controlled trials that used the same total daily antibiotic dose for both intervention arms (0.70, 0.50-0.98, fixed and random effects models). Regarding mortality and nephrotoxicity, no differences were found (mortality 0.89, 0.48-1.64; nephrotoxicity 0.91, 0.56-1.47). In conclusion, the data suggest that the administration of the same total antibiotic dose by continuous intravenous infusion may be more efficient, with regard to clinical effectiveness, compared with the intermittent mode. In an era of gradually increasing resistance among most pathogens, the potential advantages of continuous intravenous administration of antibiotics on several clinical outcomes should be further investigated.
Kasiakou
Sofia K
SK
Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece.
Sermaides
George J
GJ
Michalopoulos
Argyris
A
Soteriades
Elpidoforos S
ES
Falagas
Matthew E
ME
D000617:Aminoglycosides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy*; D004334:Drug Administration Schedule; D006801:Humans; D007260:Infusion Pumps; D007262:Infusions, Intravenous; D007668:Kidney / Q000187:drug effects; D008826:Microbial Sensitivity Tests; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D001618:beta-Lactamases / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D014640:Vancomycin; D001618:beta-Lactamases