Experts recommend a simple change to antibiotic administration that will save lives in sepsis
The Intensive Care Society (ICS) and the British Infection Association (BIA) have today issued a joint call for a significant change in the way two common antibiotics are administered to patients with severe infections, including sepsis, indicating that this will lead to a reduction in patient deaths.
For decades, in critical care settings, the optimal method of administering beta-lactam antibiotics to septic patients has been a topic of ongoing contention. Beta-lactams, such as piperacillin/tazobactam and meropenem, are most effective when their concentration in the body remains above the level needed to kill bacteria for the longest possible time. However, they have traditionally been given as short, intermittent doses. The BIA and ICS position statement stresses the need for change for critically ill patients with severe infections.
Dr Andrew Conway Morris, consultant intensive care physician and co-chair of the joint working group, said:
We know that at present only about 10% of prescriptions for these two vital drugs are given as continuous infusions, and we would like to see this proportion ramped up as soon as possible. The change is relatively simple to implement, and represents an important step in translating robust findings from research into real-life benefits for patients across the NHS.
BIA president and working group co-chair, consultant microbiologist Dr Rajeka Lazarus said:
We’ve long known about the theoretical benefits of keeping levels of some types of antibiotics high throughout the day, rather than the peaks and troughs that come from intermittent dosing. The systematic review and meta-analysis of 17 trials, including BLING III, now provides sufficient evidence of a benefit.
Prof Shondipon Laha, president of Intensive Care Society and consultant intensive care physician added:
The statement is about aligning our practice with the best available evidence in a collaborative manner. This will not only give patients the greatest chance of recovery but also reduce associated nursing time and the overall carbon footprint compared to current administrative procedures.
- The need for local protocols and agreement between professional groups.
- Confirming drug stability for continuous administration, noting that meropenem may require several infusions over a 24-hour period.
- Managing the 'off-label' indication within local medicines governance arrangements.
- The requirement for a loading dose followed by the immediate initiation of the continuous infusion.
- Confirming that the drugs can be administered via any secure venous route, including peripheral veins, without necessarily occupying a central venous catheter lumen.
BLING implementation BIA ICS position statement