Open Access Review

Continuous infusion of antibiotics in the critically ill: The new holy grail for beta-lactams and vancomycin?

Bruno Van Herendael1*, Axel Jeurissen2, Paul M Tulkens3, Erika Vlieghe45, Walter Verbrugghe6, Philippe G Jorens6 and Margareta Ieven1

Author Affiliations

1 Department of Microbiology, Antwerp University Hospital, Edegem, Belgium

2 Department of Microbiology, GZA St. Vincentius Hospital, Antwerp, Belgium

3 Cellular and Molecular Pharmacology and Centre for Clinical Pharmacy, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium

4 Department of Tropical Diseases, Antwerp University Hospital, Edegem, Belgium

5 Institute of Tropical Medicine, Antwerp, Belgium

6 Department of Intensive Care Medicine, Antwerp University Hospital, Edegem, Belgium

For all author emails, please log on.

Annals of Intensive Care 2012, 2:22  doi:10.1186/2110-5820-2-22

Published: 2 July 2012

Abstract

The alarming global rise of antimicrobial resistance combined with the lack of new antimicrobial agents has led to a renewed interest in optimization of our current antibiotics. Continuous infusion (CI) of time-dependent antibiotics has certain theoretical advantages toward efficacy based on pharmacokinetic/pharmacodynamic principles. We reviewed the available clinical studies concerning continuous infusion of beta-lactam antibiotics and vancomycin in critically ill patients. We conclude that CI of beta-lactam antibiotics is not necessarily more advantageous for all patients. Continuous infusion is only likely to have clinical benefits in subpopulations of patients where intermittent infusion is unable to achieve an adequate time above the minimal inhibitory concentration (T > MIC). For example, in patients with infections caused by organisms with elevated MICs, patients with altered pharmacokinetics (such as the critically ill) and possibly also immunocompromised patients. For vancomycin CI can be chosen, not always for better clinical efficacy, but because it is practical, cheaper, associated with less AUC24h (area under the curve >24 h)-variability, and easier to monitor.

Keywords:
Continuous infusion; Intermittent infusion; Vancomycin; Beta-lactam; Antibiotic(s); Critically ill; Pharmacokinetic/pharmacodynamic