Antibiotic administration practices involving patients with sepsis

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To find out whether any common practice exists for intravenous antibiotic administration in critical care units across UK NHS Trusts, and identify factors influencing the adoption of extended or continuous infusions” Barton et al (2019).

Abstract:

Background: Alternative administration methods are emerging as a key area of research to improve clinical efficacy of antibiotics and address concerns regarding multi-drug resistance. Extended intermittent infusions or continuous infusions of antibiotics exhibiting time-dependent kill characteristics may be favourable in critically ill septic patients, but more evidence is needed to determine best practice.

Objective: To find out whether any common practice exists for intravenous antibiotic administration in critical care units across UK NHS Trusts, and identify factors influencing the adoption of extended or continuous infusions.

Setting: UK hospitals.

Method: UK critical care pharmacists were invited to participate in a survey on behalf of all 240 critical care units via a UK Clinical Pharmacy Association message board. The survey focused on administration practices for 22 antibacterial agents.

Main outcome measure: Antibiotic administration method.

Results: Responses were received covering 64 units, a response rate of 26.2%. Common, but not uniform administration methods were apparent for 17/22 antibiotics. Four antibiotics (piperacillin/tazobactam, doripenem, meropenem and vancomycin) were more likely to be administered as continuous or extended-intermittent infusions. Choice of administration method was especially influenced by altered pk/pd properties in sepsis or severe burns patients, or by the presence of organisms requiring high minimal inhibitory concentrations.

Conclusion: Unlicensed alternative practices of antibiotic administration are widespread but only weak evidence exists of any patient benefit, such as reduced length of stay in critical care, and none showing improvement in mortality. Further research is needed to determine whether extended infusion methods offer clinically meaningful advantages over shorter licenced administration methods in patients in critical care units.

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Reference:

Barton, G.J., Morecroft, C.W. and Henney, N.C. (2019) A survey of antibiotic administration practices involving patients with sepsis in UK critical care units. International Journal of Clinical Pharmacy. November 14th. doi: 10.1007/s11096-019-00938-9. .

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