Continuous infusion of ticarcillin–clavulanate for home treatment of serious infections: clinical efficacy, safety, pharmacokinetics and pharmacodynamics

Munckhof, Wendy; Carney, John; Neilson, Gail; Neilson, John C.; Carroll, J; McWhinney, Brett; Whitby, Michael

doi:10.1016/j.ijantimicag.2005.02.008

Cited by 13 publications

(4 citation statements)

References 30 publications

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“…There have been few clinical trials, however, comparing intermittent with continuous infusion of antibiotics for treatment of osteomyelitis [71]. Safety and efficacy of continuous infusions of ticarcillin-clavulanate has been described for treatment of infections, including osteomyelitis [72]. Knowing the achievable serum concentrations and the MIC for a particular organism may be useful when selecting a drug to optimize the time above the MIC.…”

Section: Osteomyelitis: Antibiotic Pharmacokinetic and Pharmacodynamimentioning

confidence: 99%

Pharmacotherapy of diabetic foot osteomyelitis

Byren

Peters

Hoey

et al. 2009

Expert Opinion on Pharmacotherapy

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Diabetic foot osteomyelitis (DFO) complicates about 20% of diabetic foot infections (DFIs) and increases the risk of lower extremity amputation. This contentious infection is important to discuss, given the frequency with which diabetes mellitus and its complications occur and the devastating consequences of amputation. The diagnosis and management of DFO is complicated by the diverse presentations, delayed recognition, poorly defined diagnostic criteria, and lack of validated treatment regimens. Major issues of concern include when to undertake bone resection surgery and which antimicrobial agents to use, by what route, and for how long. Patients in whom DFO is suspected are best cared for by a multidisciplinary team, including infectious disease physicians or clinical microbiologists, orthopaedic, plastic and vascular surgeons, diabetologists, primary care physicians, podiatrists and specialist (especially tissue viability) nurses. Such multidisciplinary teams have repeatedly been shown to improve disease outcomes. We herein analyse the limited, and recently published, literature on the pharmacotherapy of DFO and put it into the broader context of management of DFI and osteomyelitis.

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Section: Osteomyelitis: Antibiotic Pharmacokinetic and Pharmacodynamimentioning

confidence: 99%

Pharmacotherapy of diabetic foot osteomyelitis

Byren

Peters

Hoey

et al. 2009

Expert Opinion on Pharmacotherapy

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“…The superior effectiveness of continuous infusion over intermittent infusion has been demonstrated for ␤-lactams in animal studies (2,8,25,26); however, clinical data comparing continuous and intermittent infusions are limited and consist primarily of data from small studies and case reports (1,3,6,9,10,11,19,22,28). In most of these studies, similar clinical and microbiological outcomes have been observed for the two administration techniques, but none of the studies have had sufficient power to conclude noninferiority.…”

mentioning

confidence: 99%

Randomized, Open-Label, Comparative Study of Piperacillin-Tazobactam Administered by Continuous Infusion versus Intermittent Infusion for Treatment of Hospitalized Patients with Complicated Intra-Abdominal Infection

Lau

Mercer²,

Itani

et al. 2006

Antimicrob Agents Chemother

122

129

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The purpose of this randomized, multicenter, open-label study was to compare the continuous infusion of piperacillin-tazobactam with the standard intermittent infusion in 262 hospitalized patients with complicated intra-abdominal infections. Within 1 day of surgical intervention, eligible patients were randomized (1:1) to piperacillin-tazobactam 12 g/1.5 g administered continuously over 24 h or 3 g/0.375 g administered over 30 min intermittently every 6 h for 4 to 14 days. The demographics of the patients in the groups were similar, with a median APACHE II score of 7 and a median length of hospitalization of 7 days. Among 167 clinically evaluable patients, 86.4% and 88.4% of the patients treated with the continuous infusion and the intermittent infusion, respectively, were clinically cured or improved at the test-of-cure visit (P ‫؍‬ 0.817). Bacteriological success was observed in 83.9% and 87.9% of patients (P ‫؍‬ 0.597) in the two groups, respectively, and no differences in bacteriological response by pathogen were noted. Defervesence and white blood cell count normalization occurred in the majority of patients within 3 days and were similar between patients receiving the continuous infusion and those receiving the intermittent infusion. Drug-related adverse events were generally mild and were reported in similar numbers of patients in each arm of the trial. The results of this study support continuous infusion as a safe and reasonable alternate mode of administration of piperacillin-tazobactam for the treatment of complicated intra-abdominal infection.

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“…Monckhof et al conducted a retrospective study to evaluate the efficacy and safety of home treatment of continuous infusion ticarcillin/clavulanate for serious infections. 10 The study included a prospective arm to determine pharmacodynamics and pharmacokinetics. Ninety-four patients were included in the review, including 1 pediatric patient.…”

Section: Penicillinsmentioning

confidence: 99%