Clinical outcomes with alternative dosing strategies for piperacillin/tazobactam: a systematic review and meta-analysis

PLoS One. 2015 Jan 9;10(1):e0116769. doi: 10.1371/journal.pone.0116769. eCollection 2015.

Abstract

Objectives: A better dosing strategy can improve clinical outcomes for patients. We sought to compare the extended or continuous infusion with conventional intermittent infusion of piperacillin/tazobactam, investigating which approach is better and worthy of recommendation for clinical use.

Methods: Articles were gathered from PubMed, Web of Science, ProQuest, Science Direct, Cochrane, two Chinese literature databases (CNKI, Wan Fang Data) and related ICAAC and ACCP conferences. Randomized controlled and observational studies that compared extended or continuous infusion with conventional intermittent infusion of piperacillin/tazobactam were identified from the databases above and analyzed. Two reviewers independently extracted and investigated the data. A meta-analysis was performed using Revman 5.2 software. The quality of each study was assessed. Sensitivity analysis and publication bias were evaluated.

Results: Five randomized controlled trials and nine observational studies were included in this study. All included studies had high quality and no publication bias was found. Compared to the conventional intermittent infusion approach, the extended or continuous infusion group had a significantly higher clinical cure rate (OR 1.88, 95% CI 1.29-2.73, P = 0.0009) and a lower mortality rate (OR 0.67, 95% CI 0.50-0.89, P = 0.005). No statistical difference was observed for bacteriologic cure (OR 1.40, 95% CI 0.82-2.37, P = 0.22) between the two dosing regimens. The sensitivity analysis showed the results were stable.

Conclusions: Our systematic review and meta-analysis suggested that the extended or continuous infusion strategy of piperacillin/tazobactam should be recommended for clinical use considering its higher clinical cure rate and lower mortality rate in comparison with conventional intermittent strategy. Data from this study could be extrapolated for other β-lactam antimicrobials. Therefore, this dosing strategy could be considered in clinical practice.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Anti-Bacterial Agents / adverse effects
  • Anti-Bacterial Agents / therapeutic use*
  • Bacterial Infections / drug therapy*
  • Bacterial Infections / microbiology
  • Bacterial Infections / mortality
  • Clinical Trials as Topic
  • Databases, Factual
  • Humans
  • Odds Ratio
  • Penicillanic Acid / adverse effects
  • Penicillanic Acid / analogs & derivatives*
  • Penicillanic Acid / therapeutic use
  • Piperacillin / adverse effects
  • Piperacillin / therapeutic use*
  • Renal Insufficiency / etiology
  • Tachycardia / etiology
  • Tazobactam

Substances

  • Anti-Bacterial Agents
  • Penicillanic Acid
  • Tazobactam
  • Piperacillin

Grant support

This study was supported by Peking University Third Hospital research funding. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.