Abstract
ObjectivesA better dosing strategy can improve clinical outcomes for patients. We sought to compare the extended or continuous infusion with conventional intermittent infusion of piperacillin/tazobactam, investigating which approach is better and worthy of recommendation for clinical use.MethodsArticles were gathered from PubMed, Web of Science, ProQuest, Science Direct, Cochrane, two Chinese literature databases (CNKI, Wan Fang Data) and related ICAAC and ACCP conferences. Randomized controlled and observational studies that compared extended or continuous infusion with conventional intermittent infusion of piperacillin/tazobactam were identified from the databases above and analyzed. Two reviewers independently extracted and investigated the data. A meta-analysis was performed using Revman 5.2 software. The quality of each study was assessed. Sensitivity analysis and publication bias were evaluated.ResultsFive randomized controlled trials and nine observational studies were included in this study. All included studies had high quality and no publication bias was found. Compared to the conventional intermittent infusion approach, the extended or continuous infusion group had a significantly higher clinical cure rate (OR 1.88, 95% CI 1.29-2.73, P = 0.0009) and a lower mortality rate (OR 0.67, 95% CI 0.50-0.89, P = 0.005). No statistical difference was observed for bacteriologic cure (OR 1.40, 95% CI 0.82-2.37, P = 0.22) between the two dosing regimens. The sensitivity analysis showed the results were stable.ConclusionsOur systematic review and meta-analysis suggested that the extended or continuous infusion strategy of piperacillin/tazobactam should be recommended for clinical use considering its higher clinical cure rate and lower mortality rate in comparison with conventional intermittent strategy. Data from this study could be extrapolated for other β-lactam antimicrobials. Therefore, this dosing strategy could be considered in clinical practice.
Highlights
Piperacillin/tazobactam is an extended-spectrum β-lactamase inhibitor combination antibiotic
Compared to the conventional intermittent infusion approach, the extended or continuous infusion group had a significantly higher clinical cure rate and a lower mortality rate
No statistical difference was observed for bacteriologic cure between the two dosing regimens
Summary
Piperacillin/tazobactam is an extended-spectrum β-lactamase inhibitor combination antibiotic. The bactericidal activity of piperacillin/tazobactam is optimized when drug concentrations exceed the fractional time above the minimum inhibitory concentration (fT>MIC) for at least 30% to 50% [3,4,5]. Conventional dosing of piperacillin/tazobactam is an intermittent 30-minute infusion, potentially resulting in serum concentrations below minimum inhibitory concentration (MIC) for a prolonged period of time [11]. Though a meta-analysis comparing the two dosing strategies of piperacillin/tazobactam was done, the study had some limitations. It is important and necessary to systematically investigate the clinical outcome differences between the two dosing strategies of piperacillin/tazobactam from those clinical trials in order to produce an evidence-based recommendation for clinical practice
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