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Review

Extended or Continuous Infusion of Carbapenems in Children with Severe Infections: A Systematic Review and Narrative Synthesis

by 1,2,†, 1,3,†, 3,4, 1, 5, 5,* and 1,2,*
1
Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China
2
Institute for Drug Evaluation, Peking University Health Science Center, Beijing 100191, China
3
Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
4
Department of Pharmacy, First Hospital of Tsinghua University, Beijing 100016, China
5
Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China
*
Authors to whom correspondence should be addressed.
These authors contributed equally to this work.
Academic Editor: Leonardo Pagani
Received: 8 August 2021 / Revised: 5 September 2021 / Accepted: 7 September 2021 / Published: 9 September 2021
(This article belongs to the Special Issue Appropriateness of Antibiotics in China)
We systematically reviewed the efficacy and safety of an extended or continuous infusion (EI/CI) versus short-term infusion (STI) of carbapenems in children with severe infections. Databases, including PubMed, Embase, the Cochrane Library, Clinicaltrials.gov, China National Knowledge Infrastructure, WanFang Data, and SinoMed, were systematically searched from their inceptions to 10 August 2020, for all types of studies (such as randomized controlled trials (RCTs), retrospective studies, and pharmacokinetic or population pharmacokinetic (PK/PPK) studies) comparing EI/CI versus STI in children with severe infection. There was no limitation on language, and a manual search was also conducted. The data were screened, evaluated, extracted, and reviewed by two researchers independently. Quantitative (meta-analysis) or qualitative analyses of the included studies were performed. Twenty studies (including two RCTs, one case series, six case reports, and 11 PK/PPK studies) were included in this review (CRD42020162845). The RCTs’ quality evaluation results revealed a risk of selection and concealment bias. Qualitative analysis of RCTs demonstrated that, compared with STI, an EI (3 to 4 h) of meropenem in late-onset neonatal sepsis could improve the clinical effectiveness and microbial clearance rates, and reduce the rates of mortality; however, the differences in the incidence of other adverse events were not statistically significant. Retrospective studies showed that children undergoing an EI of meropenem experienced satisfactory clinical improvement. In addition, the results of the PK/PPK study showed that an EI (3 or 4 h)/CI of carbapenems in severely infected children was associated with a more satisfactory goal achievement rate (probability of target attainment) and a cumulative fraction of response than STI therapy. In summary, the EI/CI of carbapenems in children with severe infection has a relatively sufficient PK or pharmacodynamic (PD) basis and satisfactory efficacy and safety. However, due to the limited quantity and quality of studies, the EI/CI therapy should not be used routinely in severely infected children. This conclusion should be further verified by more high-quality controlled clinical trials or observational studies based on PK/PD theories. View Full-Text
Keywords: systematic review; narrative synthesis; pharmacokinetic; pharmacodynamic; carbapenems; meropenem; continuous infusion; extended infusion; short-term infusion; children; severe infections systematic review; narrative synthesis; pharmacokinetic; pharmacodynamic; carbapenems; meropenem; continuous infusion; extended infusion; short-term infusion; children; severe infections
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MDPI and ACS Style

Zhou, P.; Zhang, Y.; Wang, Z.; Ying, Y.; Xing, Y.; Tong, X.; Zhai, S. Extended or Continuous Infusion of Carbapenems in Children with Severe Infections: A Systematic Review and Narrative Synthesis. Antibiotics 2021, 10, 1088. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics10091088

AMA Style

Zhou P, Zhang Y, Wang Z, Ying Y, Xing Y, Tong X, Zhai S. Extended or Continuous Infusion of Carbapenems in Children with Severe Infections: A Systematic Review and Narrative Synthesis. Antibiotics. 2021; 10(9):1088. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics10091088

Chicago/Turabian Style

Zhou, Pengxiang, Yahui Zhang, Zhenhuan Wang, Yingqiu Ying, Yan Xing, Xiaomei Tong, and Suodi Zhai. 2021. "Extended or Continuous Infusion of Carbapenems in Children with Severe Infections: A Systematic Review and Narrative Synthesis" Antibiotics 10, no. 9: 1088. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics10091088

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