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An Investigation into Extended Intermittent Infusions Rather Than Standard Practice of Antibiotic Administration in Critically Ill Patients with Sepsis

Barton, G (2019) An Investigation into Extended Intermittent Infusions Rather Than Standard Practice of Antibiotic Administration in Critically Ill Patients with Sepsis. Masters thesis, Liverpool John Moores University.

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Abstract

Introduction Physiological changes affecting critically ill septic patients may impact on the effectiveness of licensed methods of antibiotic administration. It has been postulated that extending the infusion time over which time-dependent action antibiotics are administered, giving for example a 4-hour infusion rather than an injection over 5 minutes, this may increase efficacy whilst not compromising safety in critically ill septic patients. However, no single study or meta-analysis of similar studies has yet shown any significant benefit in patient orientated outcomes. Even so anecdotal evidence suggests that this practice is becoming established in the critical care environment but the extent of this in the United Kingdom (UK) has never been assessed. Method A questionnaire was developed to identify current intravenous antibiotic administration practice and the factors influencing choice in UK critical care units (CCUs). This was circulated to critical care pharmacists via the United Kingdom Clinical Pharmacy Association message board. Along side this a systematic review and meta-analysis were conducted to up date the evidence base. Results 17 of the 22 antibiotics surveyed have a single method of administration used on more than 50% of the responding UK CCUs. Piperacillin/tazobactam and meropenem are used on 22.2% and 20.3% respectively of responding CCUs as extended intermittent infusions (EIIs) and vancomycin by continuous infusion (CI) on 49.2%. Respondents most commonly sited both favourable pharmacokinetic/pharmacodynamics and an improvement in patient outcomes as reasons for adopting extended infusions. In addition, continuous infusions of vancomycin are seen to be a safer and a more predictable method of administration than intermittent infusions. Where extended infusions were in use, this practise was associated with a high level of pharmacist input into the multi-professional team such as seven-day ward cover. The systematic review identified 40 randomised controlled trials comparing extended infusions to the licensed administration practice of the same antibiotic covering in total 16 different antibiotics. Statistically significant differences in clinical cure and microbiological/bacteriological cure were found in favour of extended infusion methods. A statistically significant difference in mortality was observed when time-dependent antibiotics were analysed separately. No difference in adverse events was identified between the administration methods. Conclusion Current UK critical care practice of intravenous antibiotic administration is in 17 line with the evidence base. This meta-analysis shows that extended infusions are both safe and at least as effective as standard licensed administration methods.

Item Type: Thesis (Masters)
Uncontrolled Keywords: antibiotic; critical care; infusion; sepsis
Subjects: R Medicine > R Medicine (General)
R Medicine > RM Therapeutics. Pharmacology
Divisions: Pharmacy & Biomolecular Sciences
Date Deposited: 15 Oct 2019 11:37
Last Modified: 15 Oct 2019 11:38
DOI or Identification number: 10.24377/LJMU.t.00011543
Supervisors: Henney, N and Morecroft, C
URI: http://researchonline.ljmu.ac.uk/id/eprint/11543

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