Continuous-Infusion Beta-Lactam Antibiotics is Superior to Intermittent Dosing in Septic Patients?

The bactericidal activity of antibiotics depends on the class of antibiotic used. Some antibiotics like vancomycin, aminoglycosides and fluoroquinolones are dose-dependent for their bactericidal activity. Other antibiotics like beta-lactam antibiotics are time-dependent antibiotics which depend on maintaining drug concentrations above the minimum inhibitory concentration of the targeted organisms.  Therefore, it makes sense that a continuous infusion or prolonged infusion of beta-lactam antibiotics could increase bactericidal activity of beta-lactams vs intermittent dosing.

In this meta-analysis, 632 patients from three randomized trials were studied to compare a continuous-infusion of β-lactams compared with intermittent dosing strategy in critically ill patients with sepsis or septic shock. Continuous-infusion dosing significantly lowered 30-day mortality (relative risk, 0.73; number needed to treat [NNT], 15). For piperacillin-tazobactam (Zosyn) specifically, continuous infusion compared with intermittent dosing significantly lowered mortality (RR, 0.63; NNT, 11).


Roberts JA et al. Continuous versus intermittent β-lactam infusion in severe sepsis. A meta-analysis of individual patient data from randomized trials. Am J Respir Crit Care Med 2016 Sep 15; 194:681.

Read all articles in Emergency Procedures, Infections, Medical General, medical procedures
Tags: beta-lactam antibiotics, critical illness, HPC updates, sepsis, septic shock, severe sepsis

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