Comparing Clinical Outcomes of Piperacillin-Tazobactam Administration and Dosage Strategies in Critically Ill Adult Patients: A Systematic Review and Meta-Analysis

Abstract

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 (Odds Ratio 1.56, 95% Confidence Interval 1.28-1.90, P = 0 .0001), lower mortality rates (Odds Ratio 0.68, 95% Confidence Interval 0.55-0.84, P = 0 .0003), higher microbiological success rates (Odds Ratio 1.52, 95% Confidence Interval 1.10-2.11, P = 0.01) and decreasing the length of hospital stay (Mean Difference -1.27, 95% Confidence Interval -2.45—0.08, P = 0.04) in critically ill patients.Conclusion: Results from this study show that 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. However, more rigorous scientific studies in critically ill patients are warranted to reach a sufficient level of evidence and promote further implementation of C/PI as a dosing strategy.

Association between Serum Prolactin Levels and Neurodegenerative Diseases: Systematic Review and Meta-Analysis

“…independently using the 9-star Newcastle-Ottawa Scale (NOS) and the randomized controlled trials using the Cochrane collaboration risk of bias tool [17]. The evaluation features random sequence generation, allocation concealment, blinding of the outcome assessment, blinding of subjects and personnel, analysis of selective reporting, incomplete outcome data, and other biases [18]. Each item was evaluated by 2 independent reviewers (H.D.N.…”

Optimizing antibiotic therapies to reduce the risk of bacterial resistance

“…To maximize therapeutic effect and for early reduction of bacterial burden, on the one hand it is important to consider starting treatment with a high dose of an antibiotic to achieve high drug concentrations as soon as possible [60]. On the other hand, several studies showed that continuous infusions (over 24 h) or prolonged infusions (over ≥3 h) of β-lactam antibiotics lead to better PK/PD targets attainment rates and patient outcomes than intermittent intravenous bolus administration (over 30-60 min, 1 to 6 times per day), particularly in critically ill patients and in patients with serious infections [61][62][63][64][65]. Administering β-lactams continuously or by prolonged infusion to achieve optimal PK/PD might slow the development of resistance and improve the outcomes of patients with sepsis and septic shock.…”