Optimizing ceftazidime pharmacodynamics in patients with acute exacerbation of severe chronic bronchitis

Lubasch, A

doi:10.1093/jac/dkg111

Cited by 19 publications

(17 citation statements)

References 23 publications

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“…They reported that the clinical and bacteriological efficacy of the two treatment modes was comparable, with cure rates of 90% in both groups [17]. In contrast to our findings, microbiological susceptibility after antibiotic treatment was not determined.…”

Section: Discussioncontrasting

confidence: 99%

“…In contrast to our findings, microbiological susceptibility after antibiotic treatment was not determined. However, the authors performed pharmacodynamic measurements in a small subgroup of 21 patients and observed a more favourable profile in patients receiving a continuous infusion of ceftazidime [17]. To our knowledge, our study and that of Lubasch et al are the only two investigations in COPD patients that have looked at pharmacokinetic and pharmacodynamic aspects of continuous infusion of β-lactam antibiotics in a clinical setting.…”

Section: Discussionmentioning

confidence: 66%

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Continuous vs. intermittent cefotaxime administration in patients with chronic obstructive pulmonary disease and respiratory tract infections: pharmacokinetics/pharmacodynamics, bacterial susceptibility and clinical efficacy

Zanten¹,

Oudijk²,

Nohlmans-Paulssen³

et al. 2006

Brit J Clinical Pharma

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AimTo compare the pharmacokinetics/pharmacodynamics, antibiotic resistance and clinical efficacy of continuous (CA) vs. intermittent administration (IA) of cefotaxime in patients with obstructive pulmonary disease and respiratory infections. MethodsA randomized controlled prospective nonblinded study was per formed in 93 consecutive hospitalized patients requiring antibiotics for acute exacerbations of chronic obstructive pulmonary disease. Forty-seven patients received 2 g of cefotaxime intravenously over 24 h plus a loading dose of 1 g, and 46 patients were given the drug intermittently (1 g three times daily). ResultsSimilar pathogens were identified in both groups, being mostly Haemophilus influenzae (51%), Streptococcus pneumoniae (21%) and Moraxella catharralis (18%). Mean minimal inhibitory concentration (MIC) values were also similar before and after treatment in both groups. Clinical cure was achieved in 37/40 (93%) (CA) vs. 40/43 (93%) (IA) of patients ( P = 0.93). In microbiologically evaluable patients, criteria such as 70% of treatment time with antibiotic concentrations ≥ MIC (CA 100% vs. IA 60% of patients) and/or ≥ 5 × MIC (CA 100% vs. IA 55% of patients) were significantly better following continuous administration ( P < 0.01). Samples with suboptimal antibiotic concentrations were found in 0% of CA vs. 65% of IA patients ( P < 0.01). ConclusionsAlthough clinical cure rates were comparable, continuous cefota xime administration led to significantly greater proportions of concentrations > MIC and > 5 × MIC compared with intermittent dosing. Continuous administration of cefota xime at a lower dose [2 g (CA) vs. 3 g (CI)] is equally effective pharmacodynamically and microbiologically, may be more cost-effective and offers at least the same clinical efficacy. Based on these observations, we recommend continuous administration of cefotaxime as the preferred mode of administration. Continuous vs. intermittent cefotaxime infusion in COPDBr J Clin Pharmacol 63 :1 101

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 66%

Continuous vs. intermittent cefotaxime administration in patients with chronic obstructive pulmonary disease and respiratory tract infections: pharmacokinetics/pharmacodynamics, bacterial susceptibility and clinical efficacy

Zanten¹,

Oudijk²,

Nohlmans-Paulssen³

et al. 2006

Brit J Clinical Pharma

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“…Numerous clinical comparative studies have been conducted with beta-lactams testing various dosing strategies in various patient populations including critically ill patients [85,86,151,166,169,171,172,[241][242][243][246][247][248][249][250][251][252], patients receiving extracorporeal renal circuit [244,245,253], trauma patients [254], patients with malignant diseases [255], patients with intra-abdominal infections [256], patients with chronic obstructive pulmonary disease (COPD) [257,258] and nonspecific hospitalized patients [173,[259][260][261][262] (Table 1-2). These studies have not shown whether alternative dosing approaches (i.e., CI and EI) are advantageous nor which patient groups may benefit.…”

Section: Clinical Outcomesmentioning

confidence: 99%

“…The diverse range of patient groups include critically ill patients with sepsis [151,172,243,248,261,262,266], trauma patients (86), patients with abdominal infections [256,407], COPD patients [257,258], cancer [255] and non-specific hospitalized infections [173]. Thus, meta-analyses have evaluated heterogeneous patient groups and any potential benefits of CI or IB that may exist in a particular patient group were not assessed.…”

Section: Heterogeneous Patient Populationsmentioning

confidence: 99%

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Optimizing beta-lactam antibiotic dosing in critically ill patients: Prolonged infusion versus intermittent bolus administration

Abdul‐Aziz¹,

Mohd²

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Severe sepsis is a major burden in the intensive care unit (ICU) with persistently high mortality rates. Optimization of antibiotic dosing has been suggested as an intervention to improve clinical outcomes for critically ill patients with severe sepsis. However, current antibiotic dosing guidelines may not be appropriate for these patients, as they rarely consider the altered physiology and illness severity associated with this population. Optimizing antibiotic dosing using pharmacokinetic (PK) and pharmacodynamic (PD) principles can address these critical illness-related changes and promote therapeutic success. Due to their wide spectrum of antibiotic activity and excellent safety profile, beta-lactam antibiotics are commonly used for severe infections in the ICU. Two alternative dosing approaches to traditional intermittent bolus (IB) dosing, namely continuous infusion (CI) and extended infusion (EI), have been suggested to maximize the therapeutic potential of these antibiotics in critically ill patients. Collectively, the two dosing approaches can also be referred as prolonged infusion (PI).This Thesis aims to better characterize the pharmacokinetics/pharmacodynamics (PK/PD) of betalactam antibiotics to determine whether there is any therapeutic advantage associated with PI dosing (CI and/or EI) as compared to IB dosing. This Thesis comprises of eight chapters. Chapter 1 is an introductory chapter which provides an overview of the published literature on the area of research. The discussion in Chapter 1 presents a theoretical framework behind the Thesis objectives. Chapter 1 concludes with the specific aims of this Thesis.Chapter 2 reports the findings of a prospective PK study which aimed to describe the population PK of doripenem in critically ill patients with sepsis and perform dosing simulations to develop clinically relevant dosing guidelines for these patients. Twelve critically ill participants receiving 500 mg of doripenem 8-hourly as a 1-hr infusion were enrolled. The volume of distribution (Vd) and clearance (CL) of doripenem in this patient cohort were substantially different than those usually described in non-critically patients. As current dosing guidelines were mostly derived from the non-critically ill, findings from this study suggest that the licensed "one-dose-fits-all" dosing for doripenem is unlikely to achieve optimal exposures in critically ill patients. Empirical use of PI dosing should be considered to account for PK and illness severity differences, particularly when less-susceptible pathogens are involved.ii Chapter 3 incorporates a published systematic review which compares the PK/PD data and clinical outcomes between CI and IB dosing to describe any potential merits supporting either of the two dosing approaches for critically ill patients. The findings suggest that beta-lactam CI may not be advantageous for all critically ill patients and may be beneficial in patients with severe infections.Chapter 4 describes the findings of a post hoc analysis on the Defining...

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Continuous versus intermittent infusions of antibiotics for the treatment of severe acute infections

Shiu

Wang

Tejani

et al. 2013

Cochrane Database of Systematic Reviews

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Optimizing ceftazidime pharmacodynamics in patients with acute exacerbation of severe chronic bronchitis

Abstract: The 2 x 7 h infusion of ceftazidime 2 g (C2 x 2) was clinically and bacteriologically as effective as the usual 3 x 2 g ceftazidime short-term infusion in the treatment of AECB, and demonstrated advantages in terms of pharmacodynamic parameters compared with the C3 x 2 regimen.

Cited by 19 publications

References 23 publications

Continuous vs. intermittent cefotaxime administration in patients with chronic obstructive pulmonary disease and respiratory tract infections: pharmacokinetics/pharmacodynamics, bacterial susceptibility and clinical efficacy

Continuous vs. intermittent cefotaxime administration in patients with chronic obstructive pulmonary disease and respiratory tract infections: pharmacokinetics/pharmacodynamics, bacterial susceptibility and clinical efficacy

Optimizing beta-lactam antibiotic dosing in critically ill patients: Prolonged infusion versus intermittent bolus administration

Continuous versus intermittent infusions of antibiotics for the treatment of severe acute infections

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