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Zhou P, Zhang Y, Wang Z, Ying Y, Xing Y, Tong X, Zhai S. Extended or Continuous Infusion of Carbapenems in Children with Severe Infections: A Systematic Review and Narrative Synthesis. Antibiotics (Basel) 2021; 10:antibiotics10091088. [PMID: 34572670 PMCID: PMC8470113 DOI: 10.3390/antibiotics10091088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/05/2021] [Accepted: 09/07/2021] [Indexed: 01/08/2023] Open
Abstract
We systematically reviewed the efficacy and safety of an extended or continuous infusion (EI/CI) versus short-term infusion (STI) of carbapenems in children with severe infections. Databases, including PubMed, Embase, the Cochrane Library, Clinicaltrials.gov, China National Knowledge Infrastructure, WanFang Data, and SinoMed, were systematically searched from their inceptions to 10 August 2020, for all types of studies (such as randomized controlled trials (RCTs), retrospective studies, and pharmacokinetic or population pharmacokinetic (PK/PPK) studies) comparing EI/CI versus STI in children with severe infection. There was no limitation on language, and a manual search was also conducted. The data were screened, evaluated, extracted, and reviewed by two researchers independently. Quantitative (meta-analysis) or qualitative analyses of the included studies were performed. Twenty studies (including two RCTs, one case series, six case reports, and 11 PK/PPK studies) were included in this review (CRD42020162845). The RCTs’ quality evaluation results revealed a risk of selection and concealment bias. Qualitative analysis of RCTs demonstrated that, compared with STI, an EI (3 to 4 h) of meropenem in late-onset neonatal sepsis could improve the clinical effectiveness and microbial clearance rates, and reduce the rates of mortality; however, the differences in the incidence of other adverse events were not statistically significant. Retrospective studies showed that children undergoing an EI of meropenem experienced satisfactory clinical improvement. In addition, the results of the PK/PPK study showed that an EI (3 or 4 h)/CI of carbapenems in severely infected children was associated with a more satisfactory goal achievement rate (probability of target attainment) and a cumulative fraction of response than STI therapy. In summary, the EI/CI of carbapenems in children with severe infection has a relatively sufficient PK or pharmacodynamic (PD) basis and satisfactory efficacy and safety. However, due to the limited quantity and quality of studies, the EI/CI therapy should not be used routinely in severely infected children. This conclusion should be further verified by more high-quality controlled clinical trials or observational studies based on PK/PD theories.
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Affiliation(s)
- Pengxiang Zhou
- Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China; (P.Z.); (Y.Z.); (Y.Y.)
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing 100191, China
| | - Yahui Zhang
- Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China; (P.Z.); (Y.Z.); (Y.Y.)
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China;
| | - Zhenhuan Wang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China;
- Department of Pharmacy, First Hospital of Tsinghua University, Beijing 100016, China
| | - Yingqiu Ying
- Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China; (P.Z.); (Y.Z.); (Y.Y.)
| | - Yan Xing
- Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China;
| | - Xiaomei Tong
- Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China;
- Correspondence: (X.T.); (S.Z.); Tel.: +86-(010)-82267671 (X.T.); +86-(010)-82266686 (S.Z.)
| | - Suodi Zhai
- Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China; (P.Z.); (Y.Z.); (Y.Y.)
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing 100191, China
- Correspondence: (X.T.); (S.Z.); Tel.: +86-(010)-82267671 (X.T.); +86-(010)-82266686 (S.Z.)
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Falagas ME, Tansarli GS, Ikawa K, Vardakas KZ. Reply to Soman et al and Frippiat et al. Clin Infect Dis 2013; 57:325-7. [DOI: 10.1093/cid/cit202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dulhunty JM, Roberts JA, Davis JS, Webb SAR, Bellomo R, Gomersall C, Shirwadkar C, Eastwood GM, Myburgh J, Paterson DL, Lipman J. Reply to Soman et al. Clin Infect Dis 2013; 57:323-4. [DOI: 10.1093/cid/cit201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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