Prolonged Beta-Lactam Infusions in Children: A Systematic Review and Meta-Analysis

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Annabelle Briand1, Laurie Bernier2, Alix Pincivy3

  • 1Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada; Department of Pediatrics, CHU Sainte-Justine, Montreal QC, Canada.

The Journal of Pediatrics
|August 3, 2024
PubMed

Insights

Extended or continuous infusions of beta-lactam antibiotics did not consistently improve outcomes like mortality or hospital stay in children. More research is needed to confirm their effectiveness for bacterial infections.

Area of Science:

  • Pediatric Infectious Diseases
  • Pharmacokinetics and Pharmacodynamics
  • Antimicrobial Stewardship

Background:

  • Beta-lactam antibiotics are crucial for treating bacterial infections in children.
  • Optimizing beta-lactam delivery, such as extended or continuous infusions (EI/CI), may enhance efficacy.
  • Current evidence on the clinical benefits of EI/CI in pediatric populations is inconclusive.

Purpose of the Study:

  • To evaluate whether beta-lactam EI/CI improve clinical outcomes in pediatric patients with bacterial infections.
  • To synthesize findings from existing studies comparing EI/CI with standard beta-lactam infusions in children.
  • To assess impacts on mortality, length of stay, and cure rates.

Main Methods:

  • Systematic review and meta-analysis of observational and interventional studies.
  • Inclusion criteria: children (<18 years) with proven/suspected bacterial infections receiving beta-lactam EI/CI vs. standard infusions.
  • Outcomes assessed: mortality, hospital/ICU length of stay, microbiological and clinical cure.

Main Results:

  • No significant reduction in mortality was observed with EI/CI in randomized controlled trials (RCTs).
  • Observational studies suggested a potential mortality benefit with EI/CI, but results were conflicting.
  • No difference in hospital length of stay was found; cure rates were heterogeneous and difficult to analyze due to varied definitions.

Conclusions:

  • Beta-lactam EI/CI are not consistently associated with improved mortality or reduced length of stay in pediatric patients.
  • Conflicting results regarding clinical and microbiological cure rates highlight the need for further investigation.
  • Well-designed studies in high-risk pediatric populations are required to definitively establish the efficacy of these alternative infusion strategies.
Abstract

Keywords:
anti-bacterial agentsbacterial infectionscritical caredrug administration scheduleinfantinpatientsneonatal intensive carepediatricssepsis

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