title: Clinical outcomes with alternative dosing strategies for piperacillin/tazobactam: a systematic review and meta-analysis.
abstract: OBJECTIVE
  A better dosing strategy can improve clinical outcomes for patients. We sought to compare the extended or continuous infusion with conventional intermittent infusion of piperacillin/tazobactam, investigating which approach is better and worthy of recommendation for clinical use.
  
  
  METHODS
  Articles were gathered from PubMed, Web of Science, ProQuest, Science Direct, Cochrane, two Chinese literature databases (CNKI, Wan Fang Data) and related ICAAC and ACCP conferences. Randomized controlled and observational studies that compared extended or continuous infusion with conventional intermittent infusion of piperacillin/tazobactam were identified from the databases above and analyzed. Two reviewers independently extracted and investigated the data. A meta-analysis was performed using Revman 5.2 software. The quality of each study was assessed. Sensitivity analysis and publication bias were evaluated.
  
  
  RESULTS
  Five randomized controlled trials and nine observational studies were included in this study. All included studies had high quality and no publication bias was found. Compared to the conventional intermittent infusion approach, the extended or continuous infusion group had a significantly higher clinical cure rate (OR 1.88, 95% CI 1.29-2.73, P = 0.0009) and a lower mortality rate (OR 0.67, 95% CI 0.50-0.89, P = 0.005). No statistical difference was observed for bacteriologic cure (OR 1.40, 95% CI 0.82-2.37, P = 0.22) between the two dosing regimens. The sensitivity analysis showed the results were stable.
  
  
  CONCLUSIONS
  Our systematic review and meta-analysis suggested that the extended or continuous infusion strategy of piperacillin/tazobactam should be recommended for clinical use considering its higher clinical cure rate and lower mortality rate in comparison with conventional intermittent strategy. Data from this study could be extrapolated for other β-lactam antimicrobials. Therefore, this dosing strategy could be considered in clinical practice.
authors.affiliation: Department of pharmacy, Peking University Third Hospital, Beijing, China; School of pharmaceutical sciences, Peking University, Beijing, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Yang
authors.affiliation: Department of pharmacy, Peking University Third Hospital, Beijing, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of pharmacy, The First People's Hospital of Lianyungang, Jiangsu, China.
authors.forename: Quanyu
authors.initials: Q
authors.lastname: Zhou
authors.affiliation: School of pharmaceutical sciences, Peking University, Beijing, China.
authors.forename: Yike
authors.initials: Y
authors.lastname: Wang
authors.affiliation: School of pharmaceutical sciences, Peking University, Beijing, China.
authors.forename: Lujia
authors.initials: L
authors.lastname: Chen
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D002986:Clinical Trials as Topic; D016208:Databases, Factual; D006801:Humans; D016017:Odds Ratio; D010397:Penicillanic Acid / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010878:Piperacillin / Q000009:adverse effects / Q000627:therapeutic use*; D051437:Renal Insufficiency / Q000209:etiology; D013610:Tachycardia / Q000209:etiology; D000078142:Tazobactam
chemical_list: D000900:Anti-Bacterial Agents; D010397:Penicillanic Acid; D000078142:Tazobactam; D010878:Piperacillin