TY - JOUR AU - Lipman J. AU - Roberts J. AU - Myburgh J AU - Dulhunty J. AU - Cotta M. AB -

Although there is a biological precedent for administration of beta-lactam antibiotics by continuous or extended infusion, there is no definitive evidence of a survival benefit compared with intermittent administration. The aim of this study was to explore clinician uncertainty with regard to the administration of beta-lactam antibiotics by continuous infusion. Doctors and pharmacists in Australian and New Zealand intensive care units (ICUs) were surveyed to investigate current beta-lactam antibiotic administration practices as well as the degree of uncertainty regarding the benefit of continuous infusion of two commonly used broad-spectrum beta-lactams, namely meropenem and piperacillin/tazobactam (TZP). There were 111 respondents to the survey. Intermittent infusion was reported as standard practice for meropenem (73.9%) and TZP (82.0%). A greater proportion of pharmacists compared with doctors believed continuous infusion to be more effective than intermittent administration (85.4% vs. 34.3%, respectively; P <0.001). Both groups reported uncertainty as to whether administration by continuous infusion resulted in better patient outcomes (65.9% and 74.6%, respectively; P = 0.85). Overall, 91.0% of respondents were prepared to enrol eligible patients into a definitive randomised controlled trial on beta-lactam antibiotic administration. In conclusion, there is equipoise among clinicians working in Australian and New Zealand ICUs as to whether administration by continuous infusion offers a survival benefit in critically ill patients.

AD - Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Burns, Trauma & Critical Care Research Centre, The University of Queensland, Brisbane, Queensland, Australia; School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia. Electronic address: m.o.cotta@uq.edu.au.
Burns, Trauma & Critical Care Research Centre, The University of Queensland, Brisbane, Queensland, Australia; Redcliffe Hospital, Brisbane, Queensland, Australia.
Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Burns, Trauma & Critical Care Research Centre, The University of Queensland, Brisbane, Queensland, Australia; School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia.
Critical Care and Trauma Division, The George Institute for Global Health, Sydney, New South Wales, Australia; St George Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Burns, Trauma & Critical Care Research Centre, The University of Queensland, Brisbane, Queensland, Australia. AN - 27179814 BT - International Journal of Antimicrobial Agents DA - 169520011183 DP - NLM ET - 2016/05/18 LA - Eng LB - AUS
CCT
FY16 M1 - 436-8 N1 - Cotta, Menino O
Dulhunty, Joel M
Roberts, Jason A
Myburgh, John
Lipman, Jeffrey
Int J Antimicrob Agents. 2016 Apr 25. pii: S0924-8579(16)30059-0. doi: 10.1016/j.ijantimicag.2016.02.017. N2 -

Although there is a biological precedent for administration of beta-lactam antibiotics by continuous or extended infusion, there is no definitive evidence of a survival benefit compared with intermittent administration. The aim of this study was to explore clinician uncertainty with regard to the administration of beta-lactam antibiotics by continuous infusion. Doctors and pharmacists in Australian and New Zealand intensive care units (ICUs) were surveyed to investigate current beta-lactam antibiotic administration practices as well as the degree of uncertainty regarding the benefit of continuous infusion of two commonly used broad-spectrum beta-lactams, namely meropenem and piperacillin/tazobactam (TZP). There were 111 respondents to the survey. Intermittent infusion was reported as standard practice for meropenem (73.9%) and TZP (82.0%). A greater proportion of pharmacists compared with doctors believed continuous infusion to be more effective than intermittent administration (85.4% vs. 34.3%, respectively; P <0.001). Both groups reported uncertainty as to whether administration by continuous infusion resulted in better patient outcomes (65.9% and 74.6%, respectively; P = 0.85). Overall, 91.0% of respondents were prepared to enrol eligible patients into a definitive randomised controlled trial on beta-lactam antibiotic administration. In conclusion, there is equipoise among clinicians working in Australian and New Zealand ICUs as to whether administration by continuous infusion offers a survival benefit in critically ill patients.

PY - 2016 SN - 1872-7913 (Electronic)
0924-8579 (Linking) T2 - International Journal of Antimicrobial Agents TI - Should beta-lactam antibiotics be administered by continuous infusion in critically ill patients? A survey of Australia and New Zealand intensive care unit doctors and pharmacists VL - 47 Y2 - FY16 ER -