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--Recent meta-analysis comparing continuous infusion versus intermittent bolus dosing of beta-lactam antibiotics demonstrates mortality benefit (NNT = 15) in patients with severe sepsis or septic shock. (1)
--Consider beta-lactam continuous infusion on your septic patients if your hospital pharmacy allows
[Thanks to Anne Weichold, CRNP for providing the article for this pearl!]
Additional Information
--Beta-Lactams are time-dependent antibiotics (i.e. longer time above MIC = more time killing) annd continuous infusions should have concentrations consistently above MIC.
--Previous studies not powered to demonstrate mortality benefit, but showed pharmocokinetic improvement and higher rates of clinical cure (2)
Pratical aspects
This means the patient will require an additional IV most of the time
Most hospitals do not have a pharmacy protocol for infusion of most extended-spectrum B-lactams
References
1. Roberts JA, Abdul-Aziz MH, Davis JS, et al. Continuous versus Intermittent B-Lactam Infusion in Severe Sepsis. Am J Resp Crit Care Med. 2016; 194 (6): 681-91.
2. Abdul-Aziz MH, Sulaiman H, Mat-Nor MB, et al. Beta-Lactam Infusion in Severe Sepsis (BLISS): a prospective, two-centre, open-labelled randomised controlled trial of continuous versus intermittent beta-lactam infusion in critically ill patients with severe sepsis. Intensive Care Med. 2016; 42 (10) 1535-45.