International consensus recommendations for the use of prolonged-infusion beta-lactam antibiotics: Endorsed by the American College of Clinical Pharmacy, British Society for Antimicrobial Chemotherapy, Cystic Fibrosis Foundation, European Society of Clinical Microbiology and Infectious Diseases, Infectious Diseases Society of America, Society of Critical Care Medicine, and Society of Infectious Diseases Pharmacists

Lisa T Hong¹, Kevin J Downes², Alireza FakhriRavari¹, Jacinda C Abdul-Mutakabbir^{1

3}, Joseph L Kuti⁴, Sarah Jorgensen⁵, David C Young⁶, Mohammad H Alshaer⁷, Matteo Bassetti⁸, Robert A Bonomo^{9

10}, Mark Gilchrist¹¹, Soo Min Jang¹, Thomas Lodise¹², Jason A Roberts^{13

14

15

16}, Thomas Tängdén¹⁷, Athena Zuppa², Marc H Scheetz^{18

19}

Affiliations

¹ Loma Linda University School of Pharmacy, Loma Linda, California, USA.
² Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
³ Divisions of Clinical Pharmacy and Black Diaspora and African American Studies, University of California San Diego, La Jolla, California, USA.
⁴ Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut, USA.
⁵ University of Toronto, Toronto, Ontario, Canada.
⁶ University of Utah College of Pharmacy, Salt Lake City, Utah, USA.
⁷ University of Florida College of Pharmacy, Gainesville, Florida, USA.
⁸ University of Genoa, Genoa, Italy.
⁹ Cleveland Veteran Affairs Medical Center, Cleveland, Ohio, USA.
¹⁰ Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Case Western Reserve University, Cleveland, Ohio, USA.
¹¹ Imperial College Healthcare National Health Services Trust, London, UK.
¹² Albany College of Pharmacy and Health Sciences, Albany, New York, USA.
¹³ Faculty of Medicine, University of Queensland Center for Clinical Research, Brisbane, Queensland, Australia.
¹⁴ Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia.
¹⁵ Departments of Pharmacy and Intensive Care, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
¹⁶ Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France.
¹⁷ Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
¹⁸ College of Pharmacy, Pharmacometric Center of Excellence, Midwestern University, Downers Grove, Illinois, USA.
¹⁹ Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois, USA.

PMID: 37615245
DOI: 10.1002/phar.2842

International consensus recommendations for the use of prolonged-infusion beta-lactam antibiotics: Endorsed by the American College of Clinical Pharmacy, British Society for Antimicrobial Chemotherapy, Cystic Fibrosis Foundation, European Society of Clinical Microbiology and Infectious Diseases, Infectious Diseases Society of America, Society of Critical Care Medicine, and Society of Infectious Diseases Pharmacists

Lisa T Hong et al. Pharmacotherapy. 2023 Aug.

. 2023 Aug;43(8):740-777.

doi: 10.1002/phar.2842.

Authors

Affiliations

¹ Loma Linda University School of Pharmacy, Loma Linda, California, USA.
² Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
³ Divisions of Clinical Pharmacy and Black Diaspora and African American Studies, University of California San Diego, La Jolla, California, USA.
⁴ Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut, USA.
⁵ University of Toronto, Toronto, Ontario, Canada.
⁶ University of Utah College of Pharmacy, Salt Lake City, Utah, USA.
⁷ University of Florida College of Pharmacy, Gainesville, Florida, USA.
⁸ University of Genoa, Genoa, Italy.
⁹ Cleveland Veteran Affairs Medical Center, Cleveland, Ohio, USA.
¹⁰ Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Case Western Reserve University, Cleveland, Ohio, USA.
¹¹ Imperial College Healthcare National Health Services Trust, London, UK.
¹² Albany College of Pharmacy and Health Sciences, Albany, New York, USA.
¹³ Faculty of Medicine, University of Queensland Center for Clinical Research, Brisbane, Queensland, Australia.
¹⁴ Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia.
¹⁵ Departments of Pharmacy and Intensive Care, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
¹⁶ Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France.
¹⁷ Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
¹⁸ College of Pharmacy, Pharmacometric Center of Excellence, Midwestern University, Downers Grove, Illinois, USA.
¹⁹ Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois, USA.

PMID: 37615245
DOI: 10.1002/phar.2842

Erratum in

ERRATUM.
[No authors listed] [No authors listed] Pharmacotherapy. 2024 Sep;44(9):754. doi: 10.1002/phar.2876. Epub 2023 Sep 19. Pharmacotherapy. 2024. PMID: 37724038 No abstract available.
Correction to "International consensus recommendations for the use of prolonged-infusion beta-lactam antibiotics: Endorsed by the American College of Clinical Pharmacy, British Society for Antimicrobial Chemotherapy, Cystic Fibrosis Foundation, European Society of Clinical Microbiology and Infectious Diseases, Infectious Diseases Society of America, Society of Critical Care Medicine, and Society of Infectious Diseases Pharmacists".
[No authors listed] [No authors listed] Pharmacotherapy. 2024 Sep;44(9):755-759. doi: 10.1002/phar.2905. Epub 2024 Jan 11. Pharmacotherapy. 2024. PMID: 38205910 No abstract available.

Abstract

Intravenous β-lactam antibiotics remain a cornerstone in the management of bacterial infections due to their broad spectrum of activity and excellent tolerability. β-lactams are well established to display time-dependent bactericidal activity, where reductions in bacterial burden are directly associated with the time that free drug concentrations remain above the minimum inhibitory concentration (MIC) of the pathogen during the dosing interval. In an effort to take advantage of these bactericidal characteristics, prolonged (extended and continuous) infusions (PIs) can be applied during the administration of intravenous β-lactams to increase time above the MIC. PI dosing regimens have been implemented worldwide, but implementation is inconsistent. We report consensus therapeutic recommendations for the use of PI β-lactams developed by an expert international panel with representation from clinical pharmacy and medicine. This consensus guideline provides recommendations regarding pharmacokinetic and pharmacodynamic targets, therapeutic drug-monitoring considerations, and the use of PI β-lactam therapy in the following patient populations: severely ill and nonseverely ill adult patients, pediatric patients, and obese patients. These recommendations provide the first consensus guidance for the use of β-lactam therapy administered as PIs and have been reviewed and endorsed by the American College of Clinical Pharmacy (ACCP), the British Society for Antimicrobial Chemotherapy (BSAC), the Cystic Fibrosis Foundation (CFF), the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), the Infectious Diseases Society of America (IDSA), the Society of Critical Care Medicine (SCCM), and the Society of Infectious Diseases Pharmacists (SIDP).

Keywords: beta-lactams; consensus; infectious diseases; prolonged infusion.

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References

REFERENCES

1. MacGowan A. Revisiting Beta-lactams - PK/PD improves dosing of old antibiotics. Curr Opin Pharmacol. 2011;11:470-476.
1. Drusano GL. Pharmacokinetics and pharmacodynamics of antimicrobials. Clin Infect Dis. 2007;45(Suppl 1):S89-S95.
1. Grupper M, Kuti JL, Nicolau DP. Continuous and prolonged intravenous beta-lactam dosing: implications for the clinical laboratory. Clin Microbiol Rev. 2016;29:759-772.
1. Turnidge JD. The pharmacodynamics of beta-lactams. Clin Infect Dis. 1998;27:10-22.
1. Eagle H, Fleischman R, Levy M. “Continuous” vs. “discontinuous” therapy with penicillin; the effect of the interval between injections on therapeutic efficacy. N Engl J Med. 1953;248:481-488.

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