Background and Importance The method of administration indicated in the data sheet of ceftazidime-avibactam (CAV) is by intermittent infusion (INTINF) over 120 minutes. However, continuous infusion (CONTINF) is an off-label recommendation in beta-lactam antibiotics in order to achieve the pharmacokinetics/pharmacodynamics efficacy objectives.
Aim and Objectives To compare the effectiveness of the administration of CAV by INTINF (2 g every 8 hours in adults or 50 mg/kg/8 hours in the paediatric population) versus CONTINF (6g in 24 hours).
Material and Methods An observational retrospective study including patients treated with CAV until April 2022 was conducted. Variables collected were: sex, age, empirical/directed therapy, isolated microorganism, treatment duration, previous/concomitant antibiotic, infection site, admission to intensive care unit (ICU), culture negativisation, clinical resolution and exitus.
Results 92 patients were included, 67 in the INTINF group and 25 in the CONTINF cohort (70.1% and 72.0% men, respectively). Median age was 47 (1–86) years (INTINF) and 51 (1–84) years (CONTINF).
Treatment was directed in 92.5% (INTINF) and 96.0% (CONTINF), and the main microorganisms isolated were, respectively: multidrug-resistant Pseudomonas aeruginosa (75.8% vs 76.0%), Klebsiella pneumoniae (8.1% vs 12.0%), Burkholderia cenocepacia (4.8% vs 4.0%), and others (13.3% vs 8.0%). The median duration of CAV treatment was 11 (1–58) months (CONTINF) and 10 (1–29) months (CONTINF). 79.1% (INTINF) and 80% (CONTINF) received previous antibiotic therapy, and 77.6% (INTINF) and 80% (CONTINF) of the patients received concomitant antibiotics. The infection site was: respiratory (70.0% vs 64.0%), skin and soft parts (9.0% vs 0%), bacteraemia (7.5% vs 5.0%), abdominal (6.0% vs 4.0%), and others (7.5% vs 8.0%). 50.7% (INTINF) and 80.8% (CONTINF) of the patients were admitted to the ICU.
Negativisation of the cultures was 34.3% in the INTINF cohort and 32.0% in the CONTINF group. The resolution of the infectious process in INTINF and CONTINF patients was 56.7% vs 48.0%, and exitus was 20.8% vs 40.0%, respectively.
Conclusion and Relevance In this study, the administration of CAV by INTINF showed greater effectiveness than CONTINF. Therefore, it seems essential to carry out new studies that corroborate the effectiveness of CAV administered by CONTINF.
References and/or Acknowledgements 1. Gatti M, Pea F. Continuous versus intermittent infusion of antibiotics in Gram-negative multidrug-resistant infections. Curr Opin Infect Dis. 2021 Dec 1;34(6):737–747.
Conflict of Interest No conflict of interest.
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