Implementing a Continuous or Prolonged Infusion Beta-Lactam Program in the Hospital Setting

Abstract

The increasing prevalence of antimicrobial resistance coupled with the paucity of novel antimicrobial therapies calls for the optimization of currently available anti-infective agents. Continuous (CI) and prolonged infusions (PI) are infusion techniques used to optimize the percentage of the dosing interval that free drug concentrations remain above the minimum inhibitory concentration or f T%> MIC. fT%> MIC is the recognized pharmacodynamic driver of efficacy for time-dependent antibiotics such as beta-lactams. A growing body of evidence, including pharmacokinetic-pharmacodynamic modeling, pharmacoeconomic analyses, and clinical and microbiologic outcome studies, supports the utility of CI and PI dosing as an alternative administration technique compared to traditional intermittent infusion. Consequently, CI and PI dosing regimens are of utmost interest to antimicrobial stewardship programs at both large academic and small community hospitals. The aim of this chapter is to provide a comprehensive review of the theoretical advantages, available clinical studies, and process by which an institution can implement a successful CI and PI protocol of beta-lactam antibiotics.