Carlos R. V. Kiffer, Joseph L. Kuti and David P. Nicolau. Optimization of Therapy Using Pharmacodynamic Principles: The Case for Extending the Infusion Duration for Beta-Lactam Antibiotics. Braz J Infect Dis 2008; 12 (Suppl 2): 22-27.
Abstract: We reviewed the principles of antimicrobial therapy optimization through the use of pharmacodynamic principles particularly for beta-lactam antimicrobials. The available microbiological tools for guiding therapy and their possible impact on therapy adequacy, as well as the present applications of pharmacodynamic principles for therapeutic improvement were evaluated with the objective of validating the need for more precise predictors of clinical outcome.
Concepts such as antimicrobial choice, dose and mode of administration are discussed and reviewed for most used beta-lactam compounds, such as piperacillin/tazobactam, ceftazidime, cefepime, ceftobiprole, imipenem, meropenem, ertapenem, and doripenem. In summary, extended infusion strategies have been evaluated and proved to be more efficacious and/or economically feasible than intermittent doses for the vast majority of beta-lactams, with a large amount of supporting evidence.