Prolonged or Continuous Infusion of IV Antibiotics as Initial Treatment Strategy

which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Editorial Parenteral administration of β-lactam antibiotics by intermittent intravenous infusion or intramuscular injection has been considered the optimal dosing regimen. The exposure of staphylococci, streptococci, and enterococci to different β-lac-tams shows a post-antibiotic effect (PAE) that lasts for several hours duration [1]. This phenomenon of persistent suppression of Gram-positive cocci supported the institution of intermittent dosing regimens for β-lactam antibiotics. This strategic use of these antibiotics appeared to exhibit a reasonable level of success in clinical practice. However, the increasing number of emerging cases of drug resistance, the rising incidence of Gram-negative bacillary infections, and the lack of new antibiotics suggest that it may be appropriate to consider the development of more effective means of optimizing the use of old and new antibiotics to treat infections. Considerable progress has been made over the past two decades in elucidating the exposure–response relationships of antimicrobials, particularly the pharmacokinetic (PK) and pharmacodynamic (PD) principles. New strategies for improving antimicrobial therapy should have two primary objectives, which are to improve the patient outcome and decrease the health care costs. In this regard , the continuous infusion of β-lactam antibiotics has been investigated and proposed as a new dosage regimen to achieve the most benefit with the least amount of drug [2]. The prolonged or continuous infusion of antimicrobial agents has been suggested as a means of optimizing therapy for infectious diseases. The opponents of this approach claim there is a lack of clinical evidence and the need for extensive resources to support this methodology. On the other hand, the proponents hold the position that the prolonged infusion of antimicrobials could contribute to combating the potential misuse of time-dependent antimicrobials, which has been driven by several misunderstandings. These include the fact that a laboratory-reported " S " (for " susceptible ") indicates that the agent will be effective while all " S " designations are equal. Furthermore, the manufacturer-recommended doses are always higher than required. If treatment failure occurs, it must be due to factors other than the antimicrobial agent while resistance is " inevitable, " and discovering new agents is the only solution. The prolonged infusion of time-dependent antibiotics maximizes the achievement of relevant therapeutic concentrations over time (i.e. PK) and enables the maximum action of the drug (i.e. PD). The PK/PD of antimicrobials are the …