Chicago College of Osteopathic Medicine, Downers Grove Campus, Midwestern University, Downers Grove, IL, USA.
Department of Pharmacy Practice, Midwestern University, Downers Grove Campus, Downers Grove, IL, USA.
Int J Antimicrob Agents. 2024 Oct;64(4):107309. doi: 10.1016/j.ijantimicag.2024.107309. Epub 2024 Aug 20.
Efficacy for prolonged infusion beta-lactam dosing schemes has been previously described, but there has been less focus on the safety of standard vs. prolonged infusion protocols of beta-lactams. This study explored differences in adverse drug reactions (ADRs) reported for beta-lactams between each of these infusion protocols.
A systematic review of MEDLINE literature databases via PubMed was conducted and references were reviewed. Articles were compiled and assessed with specific inclusion/exclusion criteria. We included randomised and nonrandomised, prospective, and retrospective cohort studies that reported adverse drug reactions (ADRs) due to either standard (30-60 mins) or prolonged (≥3 h) infusions of beta-lactam infusions. Total ADRs between strategies were analysed by infusion methodology. The most consistently reported ADRs were subject to meta-analysis across studies.
12 studies met inclusion/exclusion criteria with data for 4163 patients. There was insufficient data to systematically analyse neurotoxicity or cytopenias. Seven studies reported on nephrotoxicity outcomes with no significant difference in event rates between standard (n = 434/2258,19.2%) vs. prolonged infusion (n = 266/1271, 20.9%) of beta-lactams (OR = 1.08, 95% CI [0.91, 1.29]). Six studies observed diarrhoea in a total of 759 patients with no significant difference in patients of standard (n = 18/399, 4.5%) vs. prolonged (n = 19/360, 5.3%) infusion of beta-lactams (OR = 1.14, 95% CI [0.59,2.20]).
Prolonged and standard infusion schemes for beta-lactams demonstrated similar adverse event rates. Future research should focus on improved standardisation of adverse effect definitions and a priori aim to study neurotoxicity and cytopenias. Consistent recording of ADRs and standardised definitions of these reactions will be paramount to further study of this subject.
先前已经描述了延长输注β-内酰胺类药物给药方案的疗效，但对于标准与延长输注β-内酰胺类药物方案的安全性关注较少。本研究探讨了这些输注方案中报告的β-内酰胺类药物不良反应（ADR）之间的差异。
通过 PubMed 对 MEDLINE 文献数据库进行系统回顾，并对参考文献进行了审查。根据特定的纳入/排除标准对文章进行了汇编和评估。我们纳入了随机和非随机、前瞻性和回顾性队列研究，这些研究报告了由于标准（30-60 分钟）或延长（≥3 小时）输注β-内酰胺类药物而导致的药物不良反应（ADR）。通过输注方法分析策略之间的总 ADR。对研究中最一致报告的 ADR 进行了荟萃分析。
符合纳入/排除标准的 12 项研究共纳入了 4163 名患者的数据。没有足够的数据系统地分析神经毒性或细胞减少症。有 7 项研究报告了肾毒性结果，标准输注（n=434/2258，19.2%）与延长输注（n=266/1271，20.9%）β-内酰胺类药物的事件发生率之间无显著差异（OR=1.08，95%CI[0.91，1.29]）。6 项研究共观察到 759 例患者腹泻，标准输注（n=18/399，4.5%）与延长输注（n=19/360，5.3%）β-内酰胺类药物的患者之间无显著差异（OR=1.14，95%CI[0.59，2.20]）。
β-内酰胺类药物的延长和标准输注方案显示出相似的不良事件发生率。未来的研究应侧重于改善不良反应定义的标准化，并预先研究神经毒性和细胞减少症。一致记录 ADR 和这些反应的标准化定义对于进一步研究这一主题至关重要。
