Background: Recently, continuous administration of piperacillin-tazobactam has been proposed as a valuable alternative to traditional intermittent administration especially in critically ill patients. However, antibiotic dosing remains a challenge for clinicians as antibiotic dosing regimens are usually determined in non-critically-ill hospitalized adult patients. The aim was to conduct a systematic review to identify and highlight studies comparing clinical outcomes of piperacillin tazobactam dosing regimens, continuous/prolonged infusion vs intermittent infusion in critically ill patients. Meta-analyses were performed to assess the overall effect of dosing regimen on clinical efficacy.
Methods: Studies were identified systematically through searches of PubMed and Science Direct, in compliance with PRISMA guidelines. Following the systematic literature review, meta-analyses were performed using Review Manager.
Results: Twenty-three studies were included in the analysis involving 3828 critically ill adult participants in total (continuous/prolonged infusion = 2197 and intermittent infusion = 1631) from geographically diverse regions. Continuous/prolonged resulted in significantly: higher clinical cure rates (OR 1.56, 95% C.I 1.28-1.90, P = 0 .0001), lower mortality rates (OR 0.68, 95% C.I 0.55-0.84, P = 0 .0003), higher microbiological success rates (OR 1.52, 95% C.I 1.10-2.11, P = 0.01) and decreasing the length of hospital stay (OR -1.27, 95% C.I -2.45—0.08, P = 0.04) in critically ill patients.
Conclusion: There is a significant level of evidence that clinical outcome in critically ill patients is improved in patients receiving piperacillin-tazobactam via continuous/prolonged infusion. Therefore, this alternative infusion strategy could be recommended in clinical practice.
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On 08 Jun, 2020
Received 07 Jun, 2020
On 10 May, 2020
On 08 May, 2020
Invitations sent on 08 May, 2020
On 07 May, 2020
On 21 Feb, 2020
Posted 25 Feb, 2020
On 07 Apr, 2020
Received 07 Apr, 2020
Received 01 Apr, 2020
On 27 Mar, 2020
On 22 Mar, 2020
Received 22 Mar, 2020
On 02 Mar, 2020
Invitations sent on 29 Feb, 2020
On 20 Feb, 2020
On 20 Feb, 2020
On 19 Feb, 2020
On 19 Feb, 2020
On 08 Jun, 2020
Received 07 Jun, 2020
On 10 May, 2020
On 08 May, 2020
Invitations sent on 08 May, 2020
On 07 May, 2020
On 21 Feb, 2020
Posted 25 Feb, 2020
On 07 Apr, 2020
Received 07 Apr, 2020
Received 01 Apr, 2020
On 27 Mar, 2020
On 22 Mar, 2020
Received 22 Mar, 2020
On 02 Mar, 2020
Invitations sent on 29 Feb, 2020
On 20 Feb, 2020
On 20 Feb, 2020
On 19 Feb, 2020
On 19 Feb, 2020
Background: Recently, continuous administration of piperacillin-tazobactam has been proposed as a valuable alternative to traditional intermittent administration especially in critically ill patients. However, antibiotic dosing remains a challenge for clinicians as antibiotic dosing regimens are usually determined in non-critically-ill hospitalized adult patients. The aim was to conduct a systematic review to identify and highlight studies comparing clinical outcomes of piperacillin tazobactam dosing regimens, continuous/prolonged infusion vs intermittent infusion in critically ill patients. Meta-analyses were performed to assess the overall effect of dosing regimen on clinical efficacy.
Methods: Studies were identified systematically through searches of PubMed and Science Direct, in compliance with PRISMA guidelines. Following the systematic literature review, meta-analyses were performed using Review Manager.
Results: Twenty-three studies were included in the analysis involving 3828 critically ill adult participants in total (continuous/prolonged infusion = 2197 and intermittent infusion = 1631) from geographically diverse regions. Continuous/prolonged resulted in significantly: higher clinical cure rates (OR 1.56, 95% C.I 1.28-1.90, P = 0 .0001), lower mortality rates (OR 0.68, 95% C.I 0.55-0.84, P = 0 .0003), higher microbiological success rates (OR 1.52, 95% C.I 1.10-2.11, P = 0.01) and decreasing the length of hospital stay (OR -1.27, 95% C.I -2.45—0.08, P = 0.04) in critically ill patients.
Conclusion: There is a significant level of evidence that clinical outcome in critically ill patients is improved in patients receiving piperacillin-tazobactam via continuous/prolonged infusion. Therefore, this alternative infusion strategy could be recommended in clinical practice.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Figure 8
Figure 9
Figure 10
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