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dc.contributor.authorRoberts, Jason A
dc.contributor.authorBoots, Rob
dc.contributor.authorRickard, Claire M
dc.contributor.authorThomas, Peter
dc.contributor.authorQuinn, Jo
dc.contributor.authorRoberts, Darren M
dc.contributor.authorRichards, Brent
dc.contributor.authorLipman, Jeffrey
dc.date.accessioned2017-05-03T15:24:53Z
dc.date.available2017-05-03T15:24:53Z
dc.date.issued2007
dc.date.modified2009-11-13T06:37:19Z
dc.identifier.issn0305-7453
dc.identifier.doi10.1093/jac/dkl478
dc.identifier.urihttp://hdl.handle.net/10072/26670
dc.description.abstractObjectives: To compare the clinical and bacteriological outcome of critically ill patients with sepsis treated by ceftriaxone administered as a once-a-day intermittent bolus dose or by 24 h continuous infusion. Patients and methods: We conducted an open-label, randomized controlled pilot study in 57 patients clinically diagnosed with sepsis (suspected/proven infection and systemic inflammatory response syndrome) in a tertiary level intensive care unit. Patients were randomized to receive 2 g of ceftriaxone administered by once-daily intermittent bolus dosing or by 24 h continuous infusion. Clinical and bacteriological outcomes were assessed by blinded clinicians. Results: Fifty-seven patients were enrolled in the study, 50 of whom fulfilled the a priori definition of treatment for 4 or more days. The infusion (n = 29) and bolus groups (n = 28) were similar in terms of demographics, although the median age of those receiving the infusion was younger. Intention-to-treat analysis found no statistically significant differences in the primary outcomes for clinical response (P = 0.17), clinical cure [infusion n = 13/29 versus bolus n = 5/28; adjusted odds ratio (AOR) = 3.74; 95% confidence interval (95% CI) = 1.11-12.57; P = 0.06], bacteriological response (P = 0.41) and bacteriological cure (infusion n = 18/29 versus bolus 14/28; AOR = 1.64; 95% CI = 0.57-4.70; P = 0.52). However, logistic regression in patients that complied with the a priori definitions who received ceftriaxone by continuous infusion (AOR = 22.8; 95% CI = 2.24-232.3; P = 0.008) or patients with a low Acute Physiology and Chronic Health Evaluation (APACHE) II score (AOR = 0.70; 95% CI = 0.54-0.91; P = 0.008) were associated with an improved clinical outcome when age and Sepsis Organ Failure Assessment (SOFA) score at time of study entry were controlled for. Conclusions: This pilot study suggests clinical and bacteriological advantages of continuous infusion of ceftriaxone over bolus administration in critically ill patients in patients requiring 4 or more days of treatment. This sets the scene for a large multicentre double-blind randomized controlled trial to confirm these findings.
dc.description.peerreviewedYes
dc.description.publicationstatusYes
dc.languageEnglish
dc.language.isoeng
dc.publisherOxford University Press
dc.publisher.placeUnited Kingdom
dc.relation.ispartofstudentpublicationN
dc.relation.ispartofpagefrom285
dc.relation.ispartofpageto291
dc.relation.ispartofissue2
dc.relation.ispartofjournalJournal of Antimicrobial Chemotherapy
dc.relation.ispartofvolume59
dc.rights.retentionN
dc.subject.fieldofresearchMicrobiology
dc.subject.fieldofresearchMedical Microbiology
dc.subject.fieldofresearchPharmacology and Pharmaceutical Sciences
dc.subject.fieldofresearchcode0605
dc.subject.fieldofresearchcode1108
dc.subject.fieldofresearchcode1115
dc.titleIs continuous infusion ceftriaxone better than once-a-day dosing in intensive care? A randomized controlled pilot study
dc.typeJournal article
dc.type.descriptionC1 - Articles
dc.type.codeC - Journal Articles
gro.date.issued2007
gro.hasfulltextNo Full Text
gro.griffith.authorRickard, Claire
gro.griffith.authorRichards, Brent V.


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