Table 2.
Characteristics of studies comparing outcome for continuous versus intermittent administration of piperacillin
| Study | Drug | Patient population | Dosage | Study type | Outcome measure | Outcome | Remarks |
|---|---|---|---|---|---|---|---|
|
Grant 2002[49] |
Piperacillin-tazobactam |
Hospitalized patients |
12 g/d CI (n = 47) vs. 4 x 3 g/d II (n = 51) |
Prospective, open- label controlled study |
Clinical cure Microbiological cure Days to defervescence Level 1 costs Level 2 costs |
NS NS CI < II (p = 0.012) NS CI < II (p = 0.028) |
|
|
Lau 2006[42] |
Piperacillin-tazobactam |
Complicated intra- abdominal infections |
12 g/d CI (n = 130) vs. 4 x 3 g/d II (n = 132) |
RCT |
Clinical cure Mortality Adverse events |
NS NS NS |
|
|
*Rafati 2006[16] |
Piperacillin |
Septic, critically ill patients |
8 g/d CI (n = 20) vs. 4 x 3 g/d II (n = 20) |
RCT |
Mortality Rate of decrease APACHE II score Days to defervescence |
NS CI > II NS |
Lower antimicrobial dose in CI group |
|
*Lodise 2007[50] |
Piperacillin- tazobactam |
Pseudomonas aeruginosa infections, including both ICU patients (n = 126) and non-ICU patients (n = 68) |
3 x 3.375 g/d in extended infusions of 4 h (n = 102) vs. 4 or 6 x 3.375 g/d II (n = 92) |
Retrospective cohort study |
14-day mortality APACHE II < 17 APACHE II ≥ 17 Length of stay: APACHE II < 17 APACHE II ≥ 17 |
NSExtended infusion < II (p = 0,04) NSExtended infusion < II (p = 0,02) |
Lower antimicrobial dose in extended infusion group Significant outcome differences only in subpopulation with high severity of illness (APACHE II ≥ 17) |
| *Lorente 2009[51] | Piperacillin- tazobactam (+ tobramycin 7 mg/kg/d) | VAP | 16 g/d CI (n = 37) vs. 4 x 4 g/d II (n = 46) | Retrospective cohort study | Clinical cure: MIC = 4 μg/ml MIC = 8 μg/ml MIC = 16 μg/ml | NSCI > II(p = 0.02) CI > II(p = 0.02) | Significant outcome differences only in infections caused by pathogens with high MICs |
*Studies that included critically ill, ICU patients.
NS = nonsignificant; MIC = minimal inhibitory concentration; CI = continuous infusion; II = intermittent infusion; APACHE II = Acute Physiology and Chronic Health Evaluation; VAP = ventilator-associated pneumonia; RCT = randomized, controlled trial; ICU = intensive care unit.