While we are not currently doing this, we do have plans to start. Please see
comments from our Infectious Disease Clinical Pharmacist below...
Thanks,
Steve
Steve Klahn, MBA, RN, CCRN
eICU Operations Director
Baptist Health System- San Antonio, TX
(210) 297-2390
Prolonged Infusion ( 3-4 hours) of beta-lactams has shown superiority over
standard infusion times of 30-60min. This is based on the way beta-lactams
kill (Pharmacodynamics "PD"). Beta-lactams kill by maintaining concentrations
above the MIC of the organism and not by achieving high Peak concentrations and
letting the levels drift down below the MIC.
Continuous Infusion produces the same PD effect, but it occupies a line for
24hrs where the Prolonged Infusion only takes up a port for a few hours.
The efficacy of this type of dosing has been clearly demonstrated with
Piperacillin, Meropenem, Doripenem, Nafcillin and Cefepime. Not all
beta-lactams can be dosed this way due to short stability or need to be dosed
this way due to high protein binding.
Non-beta-lactams like Vancomycin have shown superiority, when given by
continuous infusion vs standard infusion times, especially for Meningitis.
The plan is to take the prolonged infusion of Zosyn, Cefepime and Meropenem to
MEC and request for all patients with ClCr>30ml/min, that Pharmacy be given
automatic substitution authority to change the infusion times. Zosyn will go
to Zosyn 3.375gm IV Q8hrs infused over 4 hours, instead of Q6hrs. Meropenem
will be 1gm IV Q8 or 12hrs infused over 4 hours and Cefepime will go to Q8 or
12hrs infused over 3 hours. So no reduction in Meropenem or Cefepime doses or
interval, just extension of infusion time.
Jaye
From:
[email protected]<mailto:[email protected]>
[mailto:[email protected]]<mailto:[mailto:[email protected]]>
On Behalf Of Shawver, Stephanie
Sent: Friday, June 01, 2012 4:55 PM
To:
[email protected]<mailto:[email protected]>
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]<mailto:[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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