Dear Stephanie,
the killing activity of beta lactams is time-dependent. The opposite example is
aminoglycosides which is concentration-dependent.
There is a trend now to administer beta lactams as an infusion for a certain
period of time to maximize the duration of exposure, while for aminoglycosides
to give them as a single adequate dose once daily.Although in vitro study for
beta lactams shows maximum killing is seen
when the time above MIC is 70% or more of the dosing interval, not every beta
lactams can be administered that way because of stability issue once it is in
diluted forms. For example, Meropenem must be finished within 3 hours once it
is diluted (however Doripenem, a newer carbapenem antibiotic may remain stable
within 4 hours in diluted forms). In the future probably will emerge newer
generation of carbapenem (which nota bene is a beta lactam) which lacks of
stability issue, so that it can be given as continuous infusion for 24 hours
without interruption.
Regards,
Dr. Hasan Surya
Fellow in Cardiothoracic Anaesthesia, National Heart Institute Malaysia
145, Jalan Tun Razak 54100, Kuala Lumpur, Malaysia
________________________________
From: "Shawver, Stephanie" <[email protected]>
To: "[email protected]" <[email protected]>
Sent: Saturday, June 2, 2012 5:54 AM
Subject: [Sepsis Groups] Extended Infusion Beta Lactam Antibiotics
Colleagues,
I am curious to hear feedback on the recent studies
indicating that extended or continuous infusion of certain beta-lactam
antibiotics have shown better outcomes for severe sepsis and septic shock
patients. Our hospital’s Sepsis Committee is considering changing the
antibiotic regime on our protocol to have the applicable beta-lactam antibiotics
infused over an extended period of time, if not continuous. Are there any other
facilities out there going this route?
Stephanie Shawver BSN, RN
Infection Prevention Practitioner & SLMV Sepsis
Coordinator
St. Luke's Magic Valley
801 Pole Line Road West | Twin Falls, ID 83301
Office: (208) 814.3052 | Email: [email protected]
Infection Prevention Line: (208)-814-5120
“ We are what we
repeatedly do. Excellence then, is not an act but a habit.” - Aristotle
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