Piperacilina-tazobactam en perfusión continua o expandida frente a perfusión intermitente / Piperacillin-tazobactam in continuous or expanded perfusion vs intermittent perfusion

Objetivo: El objetivo principal de esta revisión es analizar las diferencias de eficacia entre la administración en perfusión intermitente y la administración en perfusión continua/expandida de piperacilina-tazobactam. Como objetivos secundarios se analizan las diferencias en seguridad, parámetros farmacocinéticos/farmacodinámicos y coste-efectividad entre las 2 formas de administración. Método Se realizaron 2 búsquedas bibliográficas independientes. Se encontraron un total de 38 artículos y finalmente se incluyeron en el estudio 6. Se analizaron los artículos incluidos y se recogieron las variables diseño, tratamiento administrado a cada grupo, número de pacientes total y perteneciente a cada grupo, variables recogidas en cada estudio y resultados. Resultados Se hallaron diferencias significativas en la variable principal en 2 de los 6 estudios incluidos a favor de la perfusión continua/expandida. En el estudio de Lodise et al. se encontraron diferencias (p = 0,04) en mortalidad (31,6% en perfusión intermitente vs 12,2% en perfusión continua/expandida). En el estudio de Lorente et al. se encontraron diferencias (p = 0,001) en curación clínica (56,5% perfusión intermitente vs 89,2% en perfusión continua/expandida). En cuanto a las variables secundarias solo se encontraron diferencias en uno de los estudios en la relación coste-efectividad a favor del grupo de perfusión continua/expandida. Conclusión Los datos analizados indican que la perfusión continua/expandida sería al menos igual de eficaz que la perfusión intermitente, y que podría ser más eficaz en pacientes más graves, o con infecciones por microorganismos más resistentes, como Pseudomonas aeruginosa. Además esta forma de administración es, en teoría, más coste-efectiva (AU)

Objective: The primary objective of this review was to analyse the differences in efficacy between the administration of intermittent and continuous/expanded perfusion of piperacillin-tazobactam. Secondary objectives were to analyse the differences in safety, pharmacokinetic/pharmacodynamic parameters, and cost-effectiveness between the two forms of administration. Method: We performed two different independent bibliographic searches. We encountered a total of 38 articles, and the final number included in the study was 6. We analysed the articles and collected the following variables: design, treatment administered to each group, total number of patients and number of patients in each study, variables collected in each study, and results. Results: We encountered significant differences in the primary variable in two of the six studies favouring continuous/expanded perfusion. The study by Lodise et al found differences (P=.04)in mortality (31.6% for intermittent perfusion vs 12.2% for continuous/expanded perfusion).The study by Lorente et al found differences (P=.001) in terms of clinical recovery (56.5% for intermittent perfusion vs 89.2% for continuous/expanded perfusion). As for secondary variables, we only found differences in one of the studies in relation to cost-effectiveness, in favour of the group who underwent continuous/expanded perfusion method. Conclusion: The analysed data suggest that continuous/expanded perfusion would be at least as effective as intermittent perfusion, and that it could be more effective in severe patients with infections from more resistant micro-organisms such as Pseudomonas aeruginosa. Additionally, this form of administration is more cost-effective, at least in theory (AU)

[Piperacillin-tazobactam in continuous or expanded perfusion vs intermittent perfusion]. / Piperacilina-tazobactam en perfusión continua o expandida frente a perfusión intermitente.

OBJECTIVE: The primary objective of this review was to analyse the differences in efficacy between the administration of intermittent and continuous/expanded perfusion of piperacillin-tazobactam. Secondary objectives were to analyse the differences in safety, pharmacokinetic/pharmacodynamic parameters, and cost-effectiveness between the two forms of administration. METHOD: We performed two different independent bibliographic searches. We encountered a total of 38 articles, and the final number included in the study was 6. We analysed the articles and collected the following variables: design, treatment administered to each group, total number of patients and number of patients in each study, variables collected in each study, and results. RESULTS: We encountered significant differences in the primary variable in two of the six studies favouring continuous/expanded perfusion. The study by Lodise et al found differences (P=.04) in mortality (31.6% for intermittent perfusion vs 12.2% for continuous/expanded perfusion). The study by Lorente et al found differences (P=.001) in terms of clinical recovery (56.5% for intermittent perfusion vs 89.2% for continuous/expanded perfusion). As for secondary variables, we only found differences in one of the studies in relation to cost-effectiveness, in favour of the group who underwent continuous/expanded perfusion method. CONCLUSION: The analysed data suggest that continuous/expanded perfusion would be at least as effective as intermittent perfusion, and that it could be more effective in severe patients with infections from more resistant micro-organisms such as Pseudomonas aeruginosa. Additionally, this form of administration is more cost-effective, at least in theory.