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Annals of Intensive Care

Table 3 Characteristics of studies comparing outcome for continuous versus intermittent administration of cephalosporins

From: Continuous infusion of antibiotics in the critically ill: The new holy grail for beta-lactams and vancomycin?

Study Drug Patient population Dosage Study type Outcome measure Outcome Remarks
Bodey 1979 [36] Cefamandole (+ carbenicillin 6 x 5 g/d) FUO in neutropenic patients 12 g/d CI (n = 74) vs. 4 x 3 g/d II (n = 92) RCT Clinical cure NS Significant difference in clinical cure (in favor of CI) only in subpopulation with persistent neutropenia (p  = 0.03)
*Hanes 2000 [28] Ceftazidime Nosocomial pneumonia in critically ill trauma patients 60 mg/kg/d CI (n = 17) vs. 3 x 2 g/d II (n = 15) RCT Length of stay Duration of leucocytosis Days to defervescence NS NS NS T > MIC > 90% in both II and CI groupLower antimicrobial dose in CI group
*Nicolau 2001 [38] Ceftazidime (+tobramycin 7 mg/kg/d) Nosocomial pneumonia in ICU patients 3 g/d CI (n = 17) vs. 3 x 2 g/d II (n = 18) RCT Clinical cure Microbiological cure NS NS Lower antimicrobial dose in CI group
*Lorente 2007 [52] Ceftazidime (+tobramycin 7 mg/kg) VAP 4 g/d CI (n = 56) vs. 2 x 2 g/d II (n = 65) Retrospective, nonrandomized, historical chart review Clinical cure CI > II(p  < 0.001)  
*Roberts 2007 [35] Ceftriaxone Sepsis 2 g/d CI (n = 29) vs. 1 x 2 g/d II (n = 28) RCT Clinical cure- ITT analysisa priori NS CI > II (p  = 0.04) Significant difference in clinical cure only in an ‘a priori’ defined subgroup of patients who received at least 4  days of ceftriaxone therapy (to exclude patients that were not ill enough or too ill)
Van Zanten 2007 [17] Cefotaxime COPD exacerbations 2 g/d CI (n = 47) vs. 3 x 1 g/d II (n = 46) RCT Clinical cure NS Lower antimicrobial dose in CI group
*Georges 2005 [41] Cefepime (+ amikacin 15 mg/kg/d) Severe pneumonia or bacteremia 4 g/d CI (n = 26) vs. 2 x 2 g/d II (n = 24) RCT Clinical cure NS  
  1. *Studies that included critically ill, ICU patients.
  2. FUO = fever of unknown origin; NS = nonsignificant; RCT = randomized, controlled trial; ITT = intention to treat; CI = continuous infusion; II = intermittent infusion; VAP = ventilator-associated pneumonia; ICU = intensive care unit.
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