Table 3.
Characteristics of studies comparing outcome for continuous versus intermittent administration of cephalosporins
| 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 |
*Studies that included critically ill, ICU patients.
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.