Haseeb Abdul, Faidah Hani Saleh, Alghamdi Saleh, Alotaibi Amal F, Elrggal Mahmoud Essam, Mahrous Ahmad J, Abuhussain Safa S Almarzoky, Obaid Najla A, Algethamy Manal, AlQarni Abdullmoin, Khogeer Asim A, Saleem Zikria, Iqbal Muhammad Shahid, Ashgar Sami S, Radwan Rozan Mohammad, Mutlaq Alaa, Fatani Nayyra, Sheikh Aziz
Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia.
Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
Front Pharmacol. 2022 Sep 21;13:964005. doi: 10.3389/fphar.2022.964005. eCollection 2022.
β-lactams remain the cornerstone of the empirical therapy to treat various bacterial infections. This systematic review aimed to analyze the data describing the dosing regimen of β-lactams. Systematic scientific and grey literature was performed in accordance with Preferred Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The studies were retrieved and screened on the basis of pre-defined exclusion and inclusion criteria. The cohort studies, randomized controlled trials (RCT) and case reports that reported the dosing schedule of β-lactams are included in this study. A total of 52 studies met the inclusion criteria, of which 40 were cohort studies, 2 were case reports and 10 were RCTs. The majority of the studies (34/52) studied the pharmacokinetic (PK) parameters of a drug. A total of 20 studies proposed dosing schedule in pediatrics while 32 studies proposed dosing regimen among adults. Piperacillin (12/52) and Meropenem (11/52) were the most commonly used β-lactams used in hospitalized patients. As per available evidence, continuous infusion is considered as the most appropriate mode of administration to optimize the safety and efficacy of the treatment and improve the clinical outcomes. Appropriate antibiotic therapy is challenging due to pathophysiological changes among different age groups. The optimization of pharmacokinetic/pharmacodynamic parameters is useful to support alternative dosing regimens such as an increase in dosing interval, continuous infusion, and increased bolus doses.
β-内酰胺类药物仍然是治疗各种细菌感染的经验性治疗的基石。本系统评价旨在分析描述β-内酰胺类药物给药方案的数据。按照系统评价和Meta分析的首选项目（PRISMA）指南进行了系统的科学文献和灰色文献检索。根据预先定义的排除和纳入标准对研究进行检索和筛选。本研究纳入了报告β-内酰胺类药物给药方案的队列研究、随机对照试验（RCT）和病例报告。共有52项研究符合纳入标准，其中40项为队列研究，2项为病例报告，10项为随机对照试验。大多数研究（34/52）研究了药物的药代动力学（PK）参数。共有20项研究提出了儿科给药方案，32项研究提出了成人给药方案。哌拉西林（12/52）和美罗培南（11/52）是住院患者中最常用的β-内酰胺类药物。根据现有证据，持续输注被认为是优化治疗安全性和有效性并改善临床结局的最合适给药方式。由于不同年龄组的病理生理变化，合适的抗生素治疗具有挑战性。药代动力学/药效学参数的优化有助于支持替代给药方案，如增加给药间隔、持续输注和增加推注剂量。
