Continuous versus intermittent intravenous administration of antibiotics: A meta-analysis of randomised controlled trials

Sofia K. Kasiakou, George J. Sermaides, Argyris Michalopoulos, Elpidoforos S. Soteriades, Matthew E. Falagas

Research output: Contribution to journalReview articlepeer-review

153 Citations (Scopus)

Abstract

Intermittent intravenous administration of antibiotics is the first-line approach in the management of severe infections worldwide. However, the potential benefits of alternate modes of administration of antibiotics, including continuous intravenous infusion, deserve further evaluation. We did a meta-analysis of randomised controlled trials comparing continuous intravenous infusion with intermittent intravenous administration of the same antibiotic regimen. Nine randomised controlled trials studying beta-lactams, aminoglycosides, and vancomycin were included. Clinical failure was lower, although without statistical significance, in patients receiving continuous infusion of antibiotics (pooled OR 0.73, 95% CI 0.53-1.01); the difference was statistically significant in a subset of randomised controlled trials that used the same total daily antibiotic dose for both intervention arms (0.70, 0.50-0.98, fixed and random effects models). Regarding mortality and nephrotoxicity, no differences were found (mortality 0.89, 0.48-1.64; nephrotoxicity 0.91, 0.56-1.47). In conclusion, the data suggest that the administration of the same total antibiotic dose by continuous intravenous infusion may be more efficient, with regard to clinical effectiveness, compared with the intermittent mode. In an era of gradually increasing resistance among most pathogens, the potential advantages of continuous intravenous administration of antibiotics on several clinical outcomes should be further investigated.

Original languageEnglish
Pages (from-to)581-589
Number of pages9
JournalLancet Infectious Diseases
Volume5
Issue number9
DOIs
Publication statusPublished - Sep 2005
Externally publishedYes

ASJC Scopus subject areas

  • Infectious Diseases

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