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Updated: May 31, 2026
11:17
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Continuous infusion vs. bolus dosing: implications for beta-lactam antibiotics.
Abdul-Aziz Mohd Hafiz1, C E Staatz, C M J Kirkpatrick
1School of Pharmacy, International Islamic University of Malaysia, Kuantan, Malaysia.
Minerva Anestesiologica
|July 7, 2011
Summary
Continuous infusion of beta-lactam antibiotics optimizes pharmacokinetic/pharmacodynamic (PK/PD) properties, enhancing bacterial killing. While in vitro data strongly supports this method, further large trials are needed to confirm clinical superiority over intermittent dosing.
Area of Science:
- Pharmacology and Infectious Diseases
- Antibiotic Pharmacokinetics and Pharmacodynamics
Background:
- Beta-lactam antibiotics exhibit time-dependent pharmacodynamics, favoring sustained concentrations for effective bacterial killing.
- Continuous infusion is proposed to optimize beta-lactam pharmacokinetic/pharmacodynamic (PK/PD) profiles compared to intermittent dosing.
Purpose of the Study:
- To systematically review and compare the PK/PD and clinical outcomes of continuous versus intermittent beta-lactam infusion.
- To evaluate the evidence supporting continuous infusion for optimizing antibiotic therapy.
Main Methods:
- Systematic literature review of studies comparing continuous and intermittent infusion of beta-lactam antibiotics.
- Analysis of in vitro, in vivo PK/PD data, and clinical outcomes across diverse patient populations (critically ill, cancer, cystic fibrosis).
Main Results:
- In vitro data strongly supports continuous infusion for maximizing bacterial killing through consistent pharmacodynamic target attainment.
- Clinical data suggests equivalence between continuous and intermittent infusion, even with lower doses in continuous therapy.
- Current clinical evidence is limited by small sample sizes, lacking statistical power to definitively favor either dosing strategy.
Conclusions:
- Abundant pre-clinical data and demonstrated in vivo PK/PD advantages support continuous beta-lactam infusion.
- Larger, multi-center trials are necessary to definitively establish the clinical efficacy of continuous versus intermittent beta-lactam administration.
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