Skip to main content
Effective Health Care Program

  • March 22, 2013
    Topic Initiated
  • March 22, 2013
    Draft Key Questions
  • July 19, 2013
  • Nov. 24, 2014
    Systematic Review
  • April 16, 2015
    Disposition of Comments Report

Pharmacokinetic/Pharmacodynamic Measures for Guiding Antibiotic Treatment for Hospital-Acquired Pneumonia

Systematic Review

People using assistive technology may not be able to fully access information in these files. For additional assistance, please contact us.

Structured Abstract

Objective

To conduct a systematic review of the use of pharmacokinetic/pharmacodynamic (PK/PD) measures or strategies to dose and monitor intravenous (IV) antibiotics in the treatment of adults with hospital-acquired pneumonia (HAP).

Data sources

MEDLINE® (via PubMed), Cochrane Library, International Pharmaceutical Abstracts, and ClinicalTrials.gov from January 1, 2004, to June 7, 2014.

Review method

Two investigators independently selected, extracted data from, and rated risk of bias of studies. We graded strength of evidence based on established guidance.

Results

Ten studies (seven trials, three cohort studies) met inclusion criteria. Evidence is insufficient to conclude whether using PK/PD measures to inform decisions about dosing or monitoring IV antibiotic treatment improves either intermediate or health outcomes. One trial (rated high risk of bias) used PK/PD measures to study the impact of different antibiotic dosing levels on clinical responses, such as time on mechanical ventilation, treatment failure, and mortality.

Evidence is also insufficient to draw conclusions about the effect of continuous infusions of beta-lactam antibiotics compared with the effect of intermittent infusions on outcomes related to clinical response, mechanical ventilation, morbidity, mortality, or rates of antibiotic-related adverse events. Clinical response, duration of mechanical ventilation, superinfection, rates of antibiotic-related adverse events, and infusion-related adverse effects did not differ significantly in any study.

Conclusions

Despite the theoretical advantages of optimizing IV antibiotic dosing using PK/PD principles in patients with HAP, major gaps in the available evidence preclude our drawing conclusions or explaining clinical or policy implications. The near absence of strong evidence, particularly related to clinical applications, limits our ability to either support or oppose the adoption of various PK/PD strategies for this specific clinical purpose.