Effectiveness of Extended or Continuous vs. Bolus Infusion of Broad-Spectrum Beta-Lactam Antibiotics for Febrile Neutropenia: A Systematic Review and Meta-Analysis
Open Access
- 7 June 2023
- journal article
- review article
- Published by MDPI AG in Antibiotics
- Vol. 12 (6), 1024
- https://doi.org/10.3390/antibiotics12061024
Abstract
This systematic review aimed to compare extended infusion or continuous infusion with bolus infusion for febrile neutropenia (FN). We included clinical trials comparing extended or continuous infusion with bolus infusion of beta-lactam antibiotics as empirical treatment for FN and evaluated the clinical failure, all-cause mortality, and adverse event rates. Five articles (three randomized controlled trials (RCTs) and two retrospective studies) from 2014 to 2022 were included. Clinical failure was assessed with a risk ratio (RR) (95% coincident interval (CI)) of 0.74 (0.53, 1.05) and odds ratio (OR) (95% CI) of 0.14 (0.02, 1.17) in the 2 RCTs and retrospective studies, respectively. All-cause mortality was assessed with an RR (95% CI) of 1.25 (0.44, 3.54) and OR (95% CI) of 1.00 (0.44, 2.23) in the RCTs and retrospective studies, respectively. Only 1 RCT evaluated adverse events (with an RR (95% CI) of 0.46 (0.13, 1.65)). The quality of evidence was “low” for clinical failure and all-cause mortality in the RCTs. In the retrospective studies, the clinical failure and all-cause mortality evidence qualities were considered “very low” due to the study design. Extended or continuous infusion of beta-lactam antibiotics did not reduce mortality better than bolus infusion but was associated with shorter fever durations and fewer adverse events.Keywords
This publication has 47 references indexed in Scilit:
- Pharmacokinetics of piperacillin/tazobactam in cancer patients with hematological malignancies and febrile neutropenia after chemotherapyBMC Pharmacology and Toxicology, 2013
- Continuous Infusion of Beta-Lactam Antibiotics in Severe Sepsis: A Multicenter Double-Blind, Randomized Controlled TrialClinical Infectious Diseases, 2012
- Predictors of Mortality in Bloodstream Infections Caused by Klebsiella pneumoniae Carbapenemase-Producing K. pneumoniae: Importance of Combination TherapyClinical Infectious Diseases, 2012
- Antibiotics in critically ill patients: a systematic review of the pharmacokinetics of β-lactamsCritical Care, 2011
- Management of chemotherapy-associated febrile neutropeniaBritish Journal of Cancer, 2009
- The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and ElaborationPLoS Medicine, 2009
- Pharmacodynamics and pharmacokinetics of antibacterial drugs in the management of febrile neutropeniaThe Lancet Infectious Diseases, 2008
- EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphomas and solid tumoursEuropean Journal of Cancer, 2006
- Continuous versus intermittent intravenous administration of antibiotics: a meta-analysis of randomised controlled trialsThe Lancet Infectious Diseases, 2005