Continuous infusion versus intermittent bolus of ceftazidime for the treatment of nosocomial pneumonia

Objective

Betalactamics antibiotics exhibit concentration-independent bactericidal activity. The primary determinant of betalactamics efficacy is the duration of time that concentrations remain above the minimum inhibitory concentration (MIC). Several studies have found that ceftazidime by continuous infusion appears to optimize the pharmacodynamic profile by constantly providing concentrations in excess of the MIC of susceptible organisms over the course of therapy. Limit data exist on clinical efficacy by continuous infusion of ceftazidime. The purpose of this study was to evaluate the clinical efficacy associated with the administration of continuous infusion of ceftazidime (CI) and intermittent bolus of ceftazidime (IB) for the treatment of nosocomial pneumonia (NP) in critically ill patients.

Methods

Prospective and randomized study of patients admitted in the ICU from 1 July 2002 to 31 October 2002 and who developed late-onset NP. Pneumonias were diagnosed according to CDC criteria. NP were treated during 14 days with two antibiotics: ceftazidime plus another (aminoglycoside or quinolone). Patients were randomized in two groups: one group received CI of ceftazidime (4 g/day IV), and another group IB of ceftazidime (2 g/8 hours IV). The statistical analysis was realized by chi-square, Student t, and values P < 0.05.

Results

Twenty-seven patients were included. Both groups of patients (13 with CI and 14 with IB) were similar in age, sex, APACHE II, failure rate of different system organs (cardiovascular, respiratory, renal, hematologic, hepatic), number of organ failures, microorganisms responsible for NP, NP with bacteremia. Clinical cure in the patient group treated with ceftazidime administration by CI was higher, but not statistically significant (92% vs 60%, P = 0.08), with one-third of total doses of ceftazidime.

Conclusions

These data suggest that continuous infusion ceftazidime therapy may have more clinical efficacy and may be cheaper than intermittent bolus administration for the treatment of nosocomial pneumonia, but further larger studies are required to confirm it.