1. Ann Intensive Care. 2012 Jul 2;2(1):22. [Epub ahead of print]

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

Van Herendael B, Jeurissen A, Tulkens PM, Vlieghe E, Verbrugghe W, Jorens PG,
Ieven M.

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.

PMID: 22747633  [PubMed - as supplied by publisher]