Clinical outcomes of prolonged infusion (extended infusion or continuous infusion) versus intermittent bolus of meropenem in severe infection: A meta-analysis

PLoS One. 2018 Jul 30;13(7):e0201667. doi: 10.1371/journal.pone.0201667. eCollection 2018.

Abstract

Background: Meropenem exhibits time-dependent antimicrobial activity and prolonged infusion (PI) (extended infusion or continuous infusion, EI or CI) of meropenem can better achieve pharmacodynamics target when comparing with intermittent bolus (IB). However, the clinical outcomes between two groups remain inconclusive.

Objective: To evaluate current published literatures by meta-analysis to ascertain whether PI of meropenem can improve clinical outcomes.

Methods: Medline, Cochrane database and EMBASE were searched. Randomized control trails (RCT) and observational studies which compared the clinical outcomes of PI and IB groups were included and evaluated for quality. The data of studies were extracted and meta-analysis was performed using Revman 5.3 software.

Results: Six RCTs and 4 observation studies with relatively high quality were included in this analysis. Compared to IB group, PI group had a higher clinical success rate (odd ratio 2.10, 95% confidence interval 1.31-3.38) and a lower mortality (risk ratio 0.66, 95% confidence interval 0.50-0.88). The sensitivity analysis showed the results were stable.

Conclusion: PI of meropenem was associated with a higher clinical improvement rate and a lower mortality. It is recommended for patients with severe infection or infected by less sensitive microbial.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Anti-Bacterial Agents / administration & dosage*
  • Anti-Bacterial Agents / adverse effects
  • Drug Administration Schedule
  • Humans
  • Infections / drug therapy*
  • Infections / epidemiology
  • Infusions, Intravenous
  • Meropenem / administration & dosage*
  • Meropenem / adverse effects
  • Observational Studies as Topic / statistics & numerical data
  • Randomized Controlled Trials as Topic / statistics & numerical data
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents
  • Meropenem

Grant support

The authors received no specific funding for this work.