title: Should β-lactam antibiotics be administered by continuous infusion in critically ill patients? A survey of Australia and New Zealand intensive care unit doctors and pharmacists.
abstract: Although there is a biological precedent for administration of β-lactam antibiotics by continuous or extended infusion, there is no definitive evidence of a survival benefit compared with intermittent administration. The aim of this study was to explore clinician uncertainty with regard to the administration of β-lactam antibiotics by continuous infusion. Doctors and pharmacists in Australian and New Zealand intensive care units (ICUs) were surveyed to investigate current β-lactam antibiotic administration practices as well as the degree of uncertainty regarding the benefit of continuous infusion of two commonly used broad-spectrum β-lactams, namely meropenem and piperacillin/tazobactam (TZP). There were 111 respondents to the survey. Intermittent infusion was reported as standard practice for meropenem (73.9%) and TZP (82.0%). A greater proportion of pharmacists compared with doctors believed continuous infusion to be more effective than intermittent administration (85.4% vs. 34.3%, respectively; P <0.001). Both groups reported uncertainty as to whether administration by continuous infusion resulted in better patient outcomes (65.9% and 74.6%, respectively; P = 0.85). Overall, 91.0% of respondents were prepared to enrol eligible patients into a definitive randomised controlled trial on β-lactam antibiotic administration. In conclusion, there is equipoise among clinicians working in Australian and New Zealand ICUs as to whether administration by continuous infusion offers a survival benefit in critically ill patients.
authors.affiliation: Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Burns, Trauma & Critical Care Research Centre, The University of Queensland, Brisbane, Queensland, Australia; School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia. Electronic address: m.o.cotta@uq.edu.au.
authors.forename: Menino O
authors.initials: MO
authors.lastname: Cotta
authors.affiliation: Burns, Trauma & Critical Care Research Centre, The University of Queensland, Brisbane, Queensland, Australia; Redcliffe Hospital, Brisbane, Queensland, Australia.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Dulhunty
authors.affiliation: Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Burns, Trauma & Critical Care Research Centre, The University of Queensland, Brisbane, Queensland, Australia; School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Roberts
authors.affiliation: Critical Care and Trauma Division, The George Institute for Global Health, Sydney, New South Wales, Australia; St George Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Myburgh
authors.affiliation: Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Burns, Trauma & Critical Care Research Centre, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lipman
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001315:Australia; D003141:Communicable Diseases / Q000188:drug therapy*; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D006801:Humans; D007262:Infusions, Intravenous / Q000379:methods*; D007362:Intensive Care Units; D009520:New Zealand; D010595:Pharmacists; D010820:Physicians; D011795:Surveys and Questionnaires; D047090:beta-Lactams / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams
keywords: Continuous infusion; Critical illness; Meropenem; Piperacillin/tazobactam; Sepsis