Extended Duration Beta Lactam Infusions

Posted on Oct 1, 2019 in Announcements | 0 comments

Extended Duration Beta Lactam Infusions

Beta-lactam antibiotics exhibit bactericidal activity when the concentration of free antibiotic in the plasma exceeds the minimal inhibitory concentration (MIC) of the organism for extended periods of time. Extending the infusion duration beyond the standard 30-60 minute duration optimizes the time-dependent bactericidal activity of beta-lactam antibiotics leading to improved efficacy by maximizing the exposure of the antibiotic.1 Piperacillin/tazobactam (Zosyn), cefepime, and meropenem are the three beta-lactam antibiotics that have options for extended infusion at ABSMC. Target populations who may benefit most from extended infusion are patients who present critically ill with deep seated or severe infections, hospital acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), suspected P. aeruginosa infection and those who are infected with organisms with high MICs.2 Studies of all 3 antibiotics have demonstrated that the use of extended duration infusions is associated with clinical benefit and improved outcomes.3,4,5 Prolonged infusions do not appear to increase the risk of acute kidney injury (AKI) compared to intermittent infusions.6 Extended infusion order panels are available in EPIC with the option of selecting a bolus dose plus maintenance infusion. A loading dose infused over 30 minutes should be given prior to extended infusion to achieve adequate drug concentrations.7 If a renal dose adjustment is required, please consult pharmacy.

References:

  1. Lodise TP, et.al. Application of antimicrobial pharmacodynamic concepts into clinical practice: Focus on beta-lactam antibiotics. Pharmacotherapy 2006; 26:1321-1332.
  2. Cutro SR, Holzman R, Dubrovskaya Y, et al. Extended-Infusion versus standard-infusion piperacillin-tazobactam for sepsis syndromes at a tertiary medical center. Antimicrob Agents Chemother. 2014;58(8):4470–4475. doi:10.1128/AAC.02759-14
  3. Prolonged versus short-term intravenous infusion of antipseudomonal β-lactams for patients with sepsis: a systematic review and meta-analysis of randomized trials. Lancet Infect Dis 2018; 18(1):108-120.
  4. Yu Z, Pang X, Wu X, Shan C, Jiang S. Clinical outcomes of prolonged infusion (extended infusion or continuous infusion) versus intermittent bolus of meropenem in severe infection: A meta-analysis. PLoS One. 2018;13(7):e0201667. Published 2018 Jul 30. doi:10.1371/journal.pone.0201667
  5. Bauer KA, West JE, O’Brien JM, Goff DA. Extended-infusion cefepime reduces mortality in patients with Pseudomonas aeruginosa infections. Antimicrobial agents and chemotherapy. Jul 2013;57(7):2907-2912.
  6. Cotner SE, Rutter WC, Burgess DR, Wallace KL, Martin CA, Burgess DS. Influence of Beta Lactam Infusion Strategy on Acute Kidney Injury. Antimicrobial agents and chemotherapy. Oct 2017;61(10).
  7. Rhodes NJ, MacVane SH, Kuti JL, Scheetz MH. Impact of loading doses on the time to adequate predicted beta-lactam concentrations in prolonged and continuous infusion dosing schemes. Clin Infect Dis. 2014;59:905-907

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