Related Experiment Video
Updated: May 17, 2026
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Continuous and extended infusions of β-lactam antibiotics in the pediatric population
Mary Covington Walker1, Weng Man Lam, Kalen B Manasco
1WakeMed Health & Hospitals, Raleigh, NC, USA. marwalker@wakemed.org
Insights
This systematic review found limited evidence supporting extended or continuous infusion of beta-lactam (β-lactam) and monobactam antibiotics in pediatric patients. More research is needed to establish optimal dosing strategies for children.
Area of Science:
- Pediatric Infectious Diseases
- Pharmacology
- Antibiotic Therapy
Background:
- Extended or continuous infusion of beta-lactam (β-lactam) and monobactam antibiotics may offer therapeutic advantages.
- Optimal dosing strategies for these antibiotics in pediatric populations are not well-established.
Purpose of the Study:
- To systematically review existing data on the use of extended or continuous infusion of β-lactam and monobactam antibiotics in pediatric patients (0-18 years).
Main Methods:
- Comprehensive literature search of PubMed, International Pharmaceutical Abstracts, and Web of Science (1970-2012).
- Inclusion of randomized controlled trials, pharmacokinetic/pharmacodynamic studies, observational studies, and case reports in English.
- Search terms included pediatric populations, antibiotic classes (β-lactam, monobactam), and infusion methods (continuous, extended).
Main Results:
- Analysis included one randomized controlled trial, five pharmacokinetic studies, two pharmacodynamic studies, one case series, and seven case reports.
- Limited clinical evidence supports extended or continuous infusion of β-lactam antibiotics in pediatrics.
- Pharmacodynamic data in pediatric patients align with adult evidence for cefepime and meropenem; however, a trial on continuous ceftazidime showed no added clinical benefit over traditional dosing, despite equal efficacy.
Conclusions:
- More well-designed prospective clinical trials are necessary to determine the role and efficacy of extended or continuous infusion of β-lactam antibiotics in pediatric treatment.
- Further research is crucial for optimizing antibiotic dosing strategies in pediatric patients.
Objective:
To conduct a systematic review of available data on the use of extended or continuous infusion of β-lactam and monobactam therapy in the pediatric population (aged 0-18 years).
Data Sources:
A literature search was performed using PubMed (1975-May 2012), International Pharmaceutical Abstracts (1970-May 2012), and Web of Science (1977-May 2012) to identify studies for inclusion. In addition, reference citations from identified publications were reviewed. The following search terms were used: pediatric, children, neonate, infant, adolescent, β-lactam, cephalosporin, carbapenem, penicillin, monobactam, continuous infusion, extended infusion, and/or prolonged infusion. Individual names of drugs in each class of antibiotics were also included in the search.
Study Selection And Data Extraction:
Randomized controlled clinical trials, pharmacokinetic/pharmacodynamic studies, observational studies, and case reports involving pediatric patients who received extended or continuous infusion of β-lactam or monobactam antibiotics were reviewed. Only English-language publications were included.
Data Synthesis:
One randomized controlled clinical trial, 5 pharmacokinetic studies, 2 pharmacodynamic studies using Monte Carlo simulation, 1 case series, and 7 case reports were included in the analysis. The cephalosporin class has been studied the most and currently represents the only clinical trial using a continuous infusion dosing strategy in pediatric patients. There is limited clinical evidence available to support the use of extended or continuous infusion of β-lactam antibiotics in the pediatric population. Pharmacodynamic studies conducted in this population mirror the current evidence in adults for cefepime and meropenem. The single prospective clinical trial using continuous infusion of ceftazidime failed to demonstrate any clinical benefit over traditional dosing; however, there was equal efficacy.
Conclusions:
More well-designed prospective clinical trials are required to determine the role of extended or continuous infusion of β-lactam antibiotics in treatment of pediatric patients.
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