Extended Infusion of Beta-Lactams and Glycopeptides: A New Era in Pediatric Care? A Systematic Review and Meta-Analysis

Author:

Burch Andrea Rahel12ORCID,von Arx Lukas23,Hasse Barbara45,Neumeier Vera25ORCID

Affiliation:

1. Department of Pharmaceutical Sciences, University of Basel, 4000 Basel, Switzerland

2. University Hospital Zurich, Hospital Pharmacy, 8006 Zurich, Switzerland

3. Department of Chemistry and Applied Biosciences, Swiss Federal Institute of Technology (ETH Zurich), 8049 Zurich, Switzerland

4. Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, 8006 Zurich, Switzerland

5. University of Zurich, 8050 Zurich, Switzerland

Abstract

Optimizing antibiotic therapy is imperative with rising bacterial resistance and high infection mortality. Extended infusion defined as a continuous infusion (COI) or prolonged infusion (PI) of beta-lactams and glycopeptides might improve efficacy and safety compared to their intermittent administration (IA). This study aimed to evaluate the efficacy and safety of extended infusion in pediatric patients. Adhering to Cochrane standards, we conducted a systematic review with meta-analysis investigating the efficacy and safety of COI (24 h/d) and PI (>1 h/dose) compared to IA (≤1 h/dose) of beta-lactams and glycopeptides in pediatrics. Primary outcomes included mortality, clinical success, and microbiological eradication. Five studies could be included for the outcome mortality, investigating meropenem, piperacillin/tazobactam, cefepime, or combinations of these. The pooled relative risk estimate was 0.48 (95% CI 0.26–0.89, p = 0.02). No significant differences between the administration modes were found for the outcomes of clinical success, microbiological eradication (beta-lactams; glycopeptides), and mortality (glycopeptides). No study reported additional safety issues, e.g., adverse drug reactions when using COI/PI vs. IA. Our findings suggest that the administration of beta-lactams by extended infusion leads to a reduction in mortality for pediatric patients.

Publisher

MDPI AG

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