COMPARISON OF CONTINUOUS VERSUS INTERMITTENT ADMINISTRATION OF PIPERACILLIN-TAZOBACTAM IN INTRA-ABDOMINAL HIGH RISK INFECTIONS: A META ANALYSIS
JP Sarmiento-Reotan, PP Salandanan, ED Monsayac Cardinal Santos Medical Center
Significance: Intra-abdominal infection is an important cause of morbidity and mortality. It is the second most commonly identified cause of severe sepsis in the intensive care unit (ICU). Therefore, treatment for this kind of infection is very crucial as well as with the time and amount of money needed. It is currently established that Beta-lactam antimicrobial class, specifically Piperacillin-Tazobactam, correlates best with bacterial kill. This study was done to compare the efficacy, specifically the clinical outcome of continuous administration of Piperacillin-Tazobactam vs intermittent infusion in high-risk intra abdominal infections.
Methodology: An extensive electronic and manual literature search was performed to identify randomized control trials comparing continuous infusion from intermittent infusion of Piperacillin-Tazobactam. Abstracts of the articles selected in this search were reviewed and those meeting the inclusion criteria were recorded. The following selection criteria were applied (i) the study design was a prospective, randomized, open-label controlled trials; (ii) study population include those patient with intra-abdominal infections who were prescribed piperacillin-tazobactam during their hospital stay; (iii) patients of age 18 or above who received a minimum of 3 full days of piperacillin-tazobactam therapy (iv) outcome measures such as length of time of recovery were assessed. The quality of each complete published trial was assessed by Jadad criteria. Meta-analysis was performed by combining the risk ratios (RR) of the individual studies, using a fixed effect model. All calculations were performed with
Results: Three studies were identified. These studies included 591 subjects (298 subjects in the continuous infusion group and 294 subjects in the intermittent infusion group), compared the effects of continuous versus intermittent infusion of Piperacillin-Tazobactam. Our metaanalysis shows that the odds ratio is 1.38.
Conclusion: Continuous infusion of Piperazillin-Tazobactam has no significant difference with intermittent infusion of Piperacillin-Tazobactam among patients with high risk intra-abdominal infections. This is incongruent with previous recommendations on the use of continuous infusion of Piperacillin-Tazobactam due to its beneficial effect on the clinical outcome of patient.