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Is continuous infusion of β-lactam antibiotics worthwhile?—efficacy and pharmacokinetic considerations

Is continuous infusion of β-lactam antibiotics worthwhile?—efficacy and pharmacokinetic... The most important pharmacodynamic parameter for β-lactam antibiotics has been shown to be the time above the MIC, which is used as an argument to administer β-lactam antibiotics by continuous infusion. Studies in vitro and in laboratory animals comparing efficacy of continuous and intermittent infusion of β-lactam antibiotics generally show continuous infusion to be more efficacious. While comparative trials in humans are scarce and a significant difference was only found in subgroup analysis in one study, several case-reports support the use of continuous infusion. Arguments in favour and against continuous infusion are discussed. Although dose-ranging studies have not yet been performed in humans, the results from in-vitro and in-vivo experiments indicate that 4 × MIC for the infecting bacterium would be the target concentration. Pharmacokinetic studies which have been performed in humans during continuous infusion show that serum concentrations can be predicted from total clearance or, using population pharmacokinetic modelling, the elimination rate constant as obtained during intermittent infusion. A nomogram is presented which allows calculation of the daily dose to obtain the target steady state blood concentrations suggested by the susceptibility of the infecting bacterium, usually 4 × MIC. For bacteria with a low MIC, the daily dose may be substantially lower than that used in conventional dosing regimens, while in infections which are difficult to treat as a result of more resistant bacteria, continuous infusion may be more effective than an equivalent bolus dose. © 1996 by the British Society for Antimicrobial Chemotherapy « Previous | Next Article » Table of Contents This Article J. Antimicrob. Chemother. (1996) 38 (1): 5-15. doi: 10.1093/jac/38.1.5 » Abstract Free Full Text (PDF) Free Classifications Review Services Article metrics Alert me when cited Alert me if corrected Find similar articles Similar articles in Web of Science Similar articles in PubMed Add to my archive Download citation Request Permissions Disclaimer Citing Articles Load citing article information Citing articles via CrossRef Citing articles via Scopus Citing articles via Web of Science Citing articles via Google Scholar Google Scholar Articles by Mounton, J. W. Articles by Vinks, A. A. T. M. M. Search for related content PubMed PubMed citation Articles by Mounton, J. W. Articles by Vinks, A. A. T. M. M. Related Content Load related web page information Share Email this article CiteULike Delicious Facebook Google+ Mendeley Twitter What's this? Search this journal: Advanced » Current Issue November 2015 70 (11) Alert me to new issues The Journal About this journal Free leading articles Editor’s Choice Free Editorials JAC Supplements Rights & Permissions This journal is a member of the Committee on Publication Ethics We are mobile – find out more Journals Career Network Published on behalf of The British Society for Antimicrobial Chemotherapy Impact factor: 5.313 5-Yr impact factor: 4.984 Editor-in-Chief Dr Peter Donnelly View full editorial board For Authors Instructions to authors Online submission instructions Submit Now! Self-archiving policy Open access options for authors - visit Oxford Open This journal enables compliance with the NIH Public Access Policy WhsSvhnOkaAwYG81FJCYgwG7z1LnIP2F true Looking for your next opportunity? Looking for jobs... jQuery_1_11 = jQuery.noConflict(true); Alerting Services Email table of contents Email Advance Access CiteTrack XML RSS feed Corporate Services Advertising sales Reprints Supplements var taxonomies = ("MED00300", "MED00460"); Most Most Read Complicated urinary tract infections: practical solutions for the treatment of multiresistant Gram-negative bacteria The use of fluconazole and itraconazole in the treatment of Candida albicans infections: a review Antibacterial activity of essential oils and their major constituents against respiratory tract pathogens by gaseous contact Determination of minimum inhibitory concentrations Factors impacting on the problem of antibiotic resistance » View all Most Read articles Most Cited Methicillin-resistant Staphylococcus aureus clinical strain with reduced vancomycin susceptibility Determination of minimum inhibitory concentrations Synergy, antagonism, and what the chequerboard puts between them Intercontinental emergence of Escherichia coli clone O25:H4-ST131 producing CTX-M-15 CTX-M: changing the face of ESBLs in Europe » View all Most Cited articles Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. 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Is continuous infusion of β-lactam antibiotics worthwhile?—efficacy and pharmacokinetic considerations

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References (38)

Publisher
Oxford University Press
Copyright
Copyright © 2015 British Society for Antimicrobial Chemotherapy
ISSN
0305-7453
eISSN
1460-2091
DOI
10.1093/jac/38.1.5
Publisher site
See Article on Publisher Site

Abstract

The most important pharmacodynamic parameter for β-lactam antibiotics has been shown to be the time above the MIC, which is used as an argument to administer β-lactam antibiotics by continuous infusion. Studies in vitro and in laboratory animals comparing efficacy of continuous and intermittent infusion of β-lactam antibiotics generally show continuous infusion to be more efficacious. While comparative trials in humans are scarce and a significant difference was only found in subgroup analysis in one study, several case-reports support the use of continuous infusion. Arguments in favour and against continuous infusion are discussed. Although dose-ranging studies have not yet been performed in humans, the results from in-vitro and in-vivo experiments indicate that 4 × MIC for the infecting bacterium would be the target concentration. Pharmacokinetic studies which have been performed in humans during continuous infusion show that serum concentrations can be predicted from total clearance or, using population pharmacokinetic modelling, the elimination rate constant as obtained during intermittent infusion. A nomogram is presented which allows calculation of the daily dose to obtain the target steady state blood concentrations suggested by the susceptibility of the infecting bacterium, usually 4 × MIC. For bacteria with a low MIC, the daily dose may be substantially lower than that used in conventional dosing regimens, while in infections which are difficult to treat as a result of more resistant bacteria, continuous infusion may be more effective than an equivalent bolus dose. © 1996 by the British Society for Antimicrobial Chemotherapy « Previous | Next Article » Table of Contents This Article J. Antimicrob. Chemother. (1996) 38 (1): 5-15. doi: 10.1093/jac/38.1.5 » Abstract Free Full Text (PDF) Free Classifications Review Services Article metrics Alert me when cited Alert me if corrected Find similar articles Similar articles in Web of Science Similar articles in PubMed Add to my archive Download citation Request Permissions Disclaimer Citing Articles Load citing article information Citing articles via CrossRef Citing articles via Scopus Citing articles via Web of Science Citing articles via Google Scholar Google Scholar Articles by Mounton, J. W. Articles by Vinks, A. A. T. M. M. Search for related content PubMed PubMed citation Articles by Mounton, J. W. Articles by Vinks, A. A. T. M. M. Related Content Load related web page information Share Email this article CiteULike Delicious Facebook Google+ Mendeley Twitter What's this? Search this journal: Advanced » Current Issue November 2015 70 (11) Alert me to new issues The Journal About this journal Free leading articles Editor’s Choice Free Editorials JAC Supplements Rights & Permissions This journal is a member of the Committee on Publication Ethics We are mobile – find out more Journals Career Network Published on behalf of The British Society for Antimicrobial Chemotherapy Impact factor: 5.313 5-Yr impact factor: 4.984 Editor-in-Chief Dr Peter Donnelly View full editorial board For Authors Instructions to authors Online submission instructions Submit Now! Self-archiving policy Open access options for authors - visit Oxford Open This journal enables compliance with the NIH Public Access Policy WhsSvhnOkaAwYG81FJCYgwG7z1LnIP2F true Looking for your next opportunity? Looking for jobs... jQuery_1_11 = jQuery.noConflict(true); Alerting Services Email table of contents Email Advance Access CiteTrack XML RSS feed Corporate Services Advertising sales Reprints Supplements var taxonomies = ("MED00300", "MED00460"); Most Most Read Complicated urinary tract infections: practical solutions for the treatment of multiresistant Gram-negative bacteria The use of fluconazole and itraconazole in the treatment of Candida albicans infections: a review Antibacterial activity of essential oils and their major constituents against respiratory tract pathogens by gaseous contact Determination of minimum inhibitory concentrations Factors impacting on the problem of antibiotic resistance » View all Most Read articles Most Cited Methicillin-resistant Staphylococcus aureus clinical strain with reduced vancomycin susceptibility Determination of minimum inhibitory concentrations Synergy, antagonism, and what the chequerboard puts between them Intercontinental emergence of Escherichia coli clone O25:H4-ST131 producing CTX-M-15 CTX-M: changing the face of ESBLs in Europe » View all Most Cited articles Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department. Online ISSN 1460-2091 - Print ISSN 0305-7453 Copyright © 2015 British Society for Antimicrobial Chemotherapy Oxford Journals Oxford University Press Site Map Privacy Policy Cookie Policy Legal Notices Frequently Asked Questions Other Oxford University Press sites: Oxford University Press Oxford Journals China Oxford Journals Japan Academic & Professional books Children's & Schools Books Dictionaries & Reference Dictionary of National Biography Digital Reference English Language Teaching Higher Education Textbooks International Education Unit Law Medicine Music Online Products & Publishing Oxford Bibliographies Online Oxford Dictionaries Online Oxford English Dictionary Oxford Language Dictionaries Online Oxford Scholarship Online Reference Rights and Permissions Resources for Retailers & Wholesalers Resources for the Healthcare Industry Very Short Introductions World's Classics function fnc_onDomLoaded() { var query_context = getQueryContext(); PF_initOIUnderbar(query_context,":QS:default","","JRN"); PF_insertOIUnderbar(0); }; if (window.addEventListener) { window.addEventListener('load', fnc_onDomLoaded, false); } else if (window.attachEvent) { window.attachEvent('onload', fnc_onDomLoaded); } var gaJsHost = (("https:" == document.location.protocol) ? "https://ssl." : "http://www."); document.write(unescape("%3Cscript src='" + gaJsHost + "google-analytics.com/ga.js' type='text/javascript'%3E%3C/script%3E")); try { var pageTracker = _gat._getTracker("UA-189672-16"); pageTracker._setDomainName(".oxfordjournals.org"); pageTracker._trackPageview(); } catch(err) {}

Journal

Journal of Antimicrobial ChemotherapyOxford University Press

Published: Jul 1, 1996

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