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OBJECTIVE To compare efficacy and safety of continuous pump versus intermittent infusion of amphotericin B in the treatment of invasive fungal infection， and to provide evidence-based reference for clinical treatment. METHODS Retrieved from PubMed， the Cochrane Library， Web of Science， Embase， Wanfang， CNKI， CBM and VIP database， randomized controlled trial （RCT） and cohort study about 24 h continuous pump （trial group） versus intermittent infusion （control group） of amphotericin B were collected from the inception to Jan. 2023. After literature screening and data extraction， the quality of RCT was evaluated with modified Jadad scale， and the quality of cohort study was evaluated with Newcastle-Ottawa scale. Meta-analysis and sensitivity analysis were performed by using RevMan 5.4 software. RESULTS A total of 7 literature were included， involving 1 RCT and 6 cohort studies with a total of 767 patients. The results of meta-analysis showed that the clinical effective rate [RR＝1.44， 95%CI （1.13，1.83）， P＝0.003] of trial group was significantly higher than that of control group， and all-cause mortality rate [RR＝0.37， 95%CI（0.19，0.72），P＝0.003] and the incidence rate of infusion reaction [RR＝0.28，95%CI（0.18，0.43）， P＜0.000 01] were significantly lower than control group； there was no statistical significance in the incidence rate of renal impairment between 2 groups [RR＝0.71，95%CI（0.45，1.11），P＝0.13] . The sensitivity analysis results showed that the results obtained in this study were robust. CONCLUSIONS The efficacy and safety of 24 h continuous pump of amphotericin B are better than those of intermittent infusion in the treatment of invasive fungal infection.
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OBJECTIVE：To compare the efficacy and safety of vancomycin given by continuous infusion vs. intermittent infusion，and to provide evidence-based reference for clinical drug use. METHODS ：Retrieved from PubMed ，the Cochrane Library，Embase，Wanfang database ，CNKI and VIP databases ，ranomized controlled trials （RCT）and cohort studies about vancomycin given by continuous infusion （trial group ）vs. intermittent infusion （control group ）were collected during the inception to Apr. 2020. After literature screening and data extraction ，the qualities of RCTs were evaluated by using bias risk evaluation tool recommended by Cochrane system evaluator manual 6.0. The qualities of cohort studies were evaluated by NOS ；Rev Man 5.3 software was used to perform Meta-analysis and publication bias analysis. RESULTS ：A total of 20 studies were included （3 RCTs and 17 cohort studies ），involving 2 380 patients in total. Results of Meta-analysis showed that ，target concentration attainment rate [RR ＝1.24，95％CI（1.12，1.38），P＜0.000 1] and attainment rate of target clinical efficacy [RR ＝1.20，95％CI（1.04，1.38）， P＝0.01] of trial group was significantly higher than those of control group. The incidence of nephrotoxicity [RR ＝0.56，95％CI （0.45，0.70），P＜0.000 01] was significantly lower than control group. There was no statistical significance in the therapeutic efficiency [RR ＝1.02，95％CI（0.95，1.10），P＝0.53]，drug treatment duration [MD ＝－0.50，95％CI（－1.40，0.39），P＝0.27] or mortality [RR ＝1.03，95％CI（0.78，1.35），P＝0.83] between 2 groups. The results of publication bias showed that the probability of publication bias was high when the incidence of nephrotoxicity was used as the index. CONCLUSIONS ：Vancomycin continuous infusion can improve the attainment rate of target concentration and target clinical efficacy ，reduce the incidence of nephrotoxicity ， but can not improve the treatment efficiency. Due to the inconsistent results of publication bias analysis ，the above conclusion needs to be interpreted carefully.
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Objective To compare the renal toxicity of vancomycin with continuous infusion vs intermittent infusion. Methods The databases of EMBASE,PUBMED,the Cochrane Register of Controlled Trials,CBM,CNKI and WanFang were searched.The Cochrane Revman5.2 software was used for Meta-analysis.Results Two RCTs and eight observational studies were included in the systematic literature search with total of 1 764 patients.1 037 patients received vancomycin with continuous infusion while 727 patients with intermittent infusion.The Meta-analysis indicated that there was no significant difference in renal toxicity between continuous infusion group and intermittent infusion group(P>0.05).Conclusion Vanco-mycin continuous infusion cannot effectively reduce the incidence of renal toxicity.
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Objective To investigate the energy intake and complications of continuous and intermittent pump feeding in acute stroke patients and provide a theoretical evidence to support for clinical treatment.Methods From April 2012 to June 2016,69 acute srtoke patients on the nasogastric tube feeding and admitted in the Department of Neurology intensive care unit in Xijing Hospital were enrolled and randomly assigned to have continuous or intermittent pump feeding.The primary endpoint was the efficacy in supplying the desired amount of nutrients by the fifth day and complications(hospital-acquired pneumonia,diarrhea,gastric retention,gastrointestinal bleeding)during the first week.The secondary endpoint was nutritional assessments(albumin,prealbumin,transferrin,hypersensitive c-reactive protein)in the first week.Results Both groups were comparable in acute physiology and chronic health evaluation Ⅱ(13.3±4.7 vs.12.9±4.5),Glasgow coma scale[10(7.2,14)vs.9.5(7.7,12)],National Institute of Health stroke scale[17(15,19)vs.16(13,20)],and Barthel scores[5(0,12.5)vs.10(5,15)](all P>0.05).It was no significantly different in the achievement percentage of the energy determined in the fifth day [93.9％(77.9％,99.8％)in continuous group and 84.8％(75.7％,93.9％)in intermittent group(U=0.144,P>0.05).Intermittent pump feeding significantly reduced the rate of hospital-acquired pneumonia in the first week when compared with continuous pump feeding(58.3％vs.33.3％,X2=4.327,P=0.038),and both groups displayed a moderate number of digestive complications without significant differences,including diarrhea(30.6％vs.27.3％,X2=0.09,P=0.764),gastric retention(2.78％vs.3.03％,X2=0.001,P=1.000),and gastrointestinal bleeding(5.56％vs.9.10％,X2=0.010,P=0.920).No difference could be demonstrated in serum protein markers between two groups in the first week,including prealbumin[0.17(0.13,0.20)g/L vs.0.18(0.15,0.24)g/L,P=0.195),transferrin[1.90(1.52,2.20)g/L vs.1.94(1.65,2.06)g/L,P=0.747),and hypersensitive C-reactive protein[22.5(8.3,50.1)mg/L vs.14.6(6.5,30.5)mg/L,P=0.205].Conclusions Both continuous and intermittent pump feeding can reach the target predictive nutrition(100％of calculated caloric requirements)without statistical differences in the incidences of gastrointestinal complications,and the rate of HAP is lower in intermittent group.Intermittent enteral nutrition can be used as an appropriate method of enteral nutrition support to improve the nutritional status in critically acute stroke patients.
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Objective Effectiveness of two kinds of thermochemotherapy infusion from intraarterial approach were studied in the grafted liver VX2 tumors of rabbit.Methods VX2 tumor model was established in 30 Newzland rabbit's livers.Percutaneous transfemoral hepatic arterial catheterization with fixation of the cathether tip inside the feeding vessel was carried out under DSA guidance.All 30 rabbits were divided into three groups(n=10 in each group),normal temperature 100 ml saline+Adriamycin(ADM)infusion(group 1),60℃100 ml saline+ADM continuous perfusion(group 2)and 60℃100 ml saline+ADM intermittent perfusion(group 3).After the perfusion,the lasting time periods of 43-45℃for tumor tissue of group 2 and 3 together with the concentrations of ADM within tumor's tissue were measured.Results Concentrations of ADM were shown as(12.013?2.237)?g/ml,(17.622?1.368)?g/ml,and(11.519?1.225)?g/ml for group 2, group 3 and group 1 respectively.60℃intermittent perfusion vs 60℃continuous perfusion showed P＜0.05, 60℃continuous pefusion vs normal temperature perfusion also showed P＞0.05. 43-45℃period lasting time (min)for 60℃continuous pefusion vs 60℃intermittent pefusion were(4.1?2.7)min and(11.3?3.3)min respectively,the latter was three times more than the former.There were no differences shown betwen the temperature,respiration and heart rate of group 2 and group 3.Conclusion Intermittent intraarterial perfusion thermochemotherapy is a more effective interventional management among all thermochemotherapies.
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BACKGROUND: We investigated this study to elucidate the clinical characteristics of herpes zoster in immunocompromised patients and to analyze the pharmacokinetics of acyclovir with the response of therapy. METHODS: A total of 51 immunocompromised patients with herpes zoster were studied prospectively over 22 months (Dec. 1997-Sep. 1999). Patients were randomized to 4 groups according to pharmaceutical company (company A or B) and method of infusion (intermittently or continuously) of acyclovir. Patients were assigned to receive acyclovir (10 mg/kg, three times daily) intermittently, or acyclovir (5 mg/kg bolus, and then 40 mg/kg/day) continuously for 7 days respectively. RESULTS: Mean age was 31.9+/-12.6 years and the ratio of male to female was 1:1.68. Dermatome involvement was most frequently on the thoracic dermatome (49%), followed by cervical, lumbar dermatome. Forty-two (82.3%) patients received hematopoietic stem cell transplantation and herpes zoster was most prevalent in average 9.2+/-7.9 months after transplantation. Thirty (58%) patients had been taken immunosuppressants at the onset of herpes zoster. Recurrence rate of herpes zoster was 7.8%. Overall adverse experience rate was 15.7%. Pharmacokinetic parameter of acyclovir from company B was close to reference as compared with those of company A. There was no difference in steady-state concentration (Css) of acyclovir between intermittent and continuous infusion. Cessation of new lesion formation occurred 4.1+/-1.3 days after initiation of therapy without statistically significant intergroup differences. Rate to loss of vesicle over 50% at the seventh day of infusion also showed no intergroup differences, but tended to highest at the continuous group of company B. CONCLUSION: Herpes zoster in immunocompromised patients were prevalent during the use of immunosuppressant, mostly within 1 year after hematopoietic stem cell transplantation. Anatomical distribution was just like that of immunocompetent patients, but recurred more frequently. Clinical response was not different according to the pharmaceutical company or method of infusion. Supplementary evaluation to the dose of acyclovir, method of infusion, duration of treatment, and alternatives may be required.