Evaluating antibiotic medications delivered through elastomeric devices in a paediatric population: a systematic
Lee Shipman1, Vissagan Sankaranarayanan2, Abhishek Agarwal2
1Paediatric Oncology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK Leeshipman@nhs.net.
Insights
Elastomeric devices (EDs) effectively deliver antibiotics for pediatric patients, showing promise for outpatient parenteral antimicrobial therapy. Few adverse events were reported, but more research on safety and cost-effectiveness is needed.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
- Medical Device Technology
Background:
- Elastomeric devices (EDs) facilitate 24-hour intravenous antibiotic infusions for outpatient parenteral antimicrobial therapy.
- Systematic review focused on the use of EDs in pediatric populations (0-21 years).
Purpose of the Study:
- To systematically review the literature on the use of elastomeric devices for antibiotic delivery in children.
- To assess the efficacy, safety, and types of infections treated with EDs in pediatric patients.
Main Methods:
- Systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
- Searched multiple databases including Medline, Embase, CINAHL, PubMed, Cochrane Library, ClinicalTrials.gov, and WHO ICTRP.
- Included studies involving antibiotic delivery via EDs in pediatric patients (0-21 years).
Main Results:
- Nine studies involving 567 patients and 657 treatment episodes were included.
- Various antibiotics were delivered via EDs, primarily for cystic fibrosis exacerbations and bone/joint infections.
- Limited efficacy data showed non-inferiority in two studies for CF patients; low treatment failure (6%) and few adverse events (3% ED failure, 1 crystallisation case) were reported.
Conclusions:
- Elastomeric devices are utilized for diverse antimicrobial agents in children, particularly for cystic fibrosis patients.
- Reported adverse events are infrequent, but further research is needed on safety and cost-effectiveness in pediatric populations.
- Future studies should explore new patient groups and expand evidence on EDs in pediatric care.
Background:
Elastomeric devices (EDs) allow infusion of antibiotic via an intravenous catheter over 24 hours, supporting outpatient parenteral antimicrobial therapy. We conducted a systematic review of these devices in a paediatric population.
Methods:
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was used to review studies assessing antibiotic delivery through EDs in a paediatric population (0-21 years). Medline, Embase, CINAHL, PubMed, The Cochrane Clinical Trials Library, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform were searched.
Results:
After deduplication, 1789 titles and abstracts were screened; 45 underwent full-text review and nine were suitable for qualitative synthesis. 567 patients were treated in 657 episodes. 14 different antibiotics and aciclovir were delivered through EDs, primarily 24-hour infusions. Median treatment duration was 10 to 15 days. A variety of infections were treated (mostly infective exacerbations of cystic fibrosis (CF), bone/joint infection). Efficacy data were limited; two studies demonstrated non-inferiority of antibiotic therapy via ED for CF patients compared with conventional infusion pumps. In another study, only two patients (6%) experienced treatment failure. Few adverse events were reported: 1 of 34 patients (3%) experienced ED failure due to misplacement of the central line; one case of antibiotic crystallisation.
Conclusion:
EDs have been used for a range of antimicrobial agents in children, in the treatment of a variety of infections, mostly in CF patients, and few adverse events were reported. Further studies should concentrate on new patient groups, and specific information about safety and cost effectiveness of ED in children is required.
Prospero Registration Number:
CRD42021237146.
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