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Evaluating antibiotic medications delivered through elastomeric devices in a paediatric population: a systematic review

Evaluating antibiotic medications delivered through elastomeric devices in a paediatric population: a systematic review
Evaluating antibiotic medications delivered through elastomeric devices in a paediatric population: a systematic review
Background: elastomeric devices (EDs) allow infusion of antibiotic via an intravenous catheter over 24 hours, supporting outpatient parenteral antimicrobial therapy. We conducted a systematic review of these devices in a paediatric population.

Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was used to review studies assessing antibiotic delivery through EDs in a paediatric population (0–21 years). Medline, Embase, CINAHL, PubMed, The Cochrane Clinical Trials Library, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform were searched.

Results: after deduplication, 1789 titles and abstracts were screened; 45 underwent full-text review and nine were suitable for qualitative synthesis. 567 patients were treated in 657 episodes. 14 different antibiotics and aciclovir were delivered through EDs, primarily 24-hour infusions. Median treatment duration was 10 to 15 days. A variety of infections were treated (mostly infective exacerbations of cystic fibrosis (CF), bone/joint infection). Efficacy data were limited; two studies demonstrated non-inferiority of antibiotic therapy via ED for CF patients compared with conventional infusion pumps. In another study, only two patients (6%) experienced treatment failure. Few adverse events were reported: 1 of 34 patients (3%) experienced ED failure due to misplacement of the central line; one case of antibiotic crystallisation.

Conclusion: EDs have been used for a range of antimicrobial agents in children, in the treatment of a variety of infections, mostly in CF patients, and few adverse events were reported. Further studies should concentrate on new patient groups, and specific information about safety and cost effectiveness of ED in children is required.
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Shipman, Lee
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Sankaranarayanan, Vissagan
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Agarwal, Abhishek
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Chacko, Jerry
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Charras, Amandine
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Swain, Violet
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Sposito, Francesca
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Aragon, Octavio
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Porter, David
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Patel, Sanjay Valabh
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Green, Helen
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Faust, Saul N.
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Bryant, Penelope A.
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Pizer, Barry
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Hawcutt, Daniel
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Shipman, Lee
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Sankaranarayanan, Vissagan
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Agarwal, Abhishek
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Chacko, Jerry
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Charras, Amandine
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Swain, Violet
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Sposito, Francesca
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Aragon, Octavio
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Porter, David
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Patel, Sanjay Valabh
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Green, Helen
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Faust, Saul N.
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Bryant, Penelope A.
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Pizer, Barry
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Hawcutt, Daniel
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Shipman, Lee, Sankaranarayanan, Vissagan, Agarwal, Abhishek, Chacko, Jerry, Charras, Amandine, Swain, Violet, Sposito, Francesca, Aragon, Octavio, Porter, David, Patel, Sanjay Valabh, Green, Helen, Faust, Saul N., Bryant, Penelope A., Pizer, Barry and Hawcutt, Daniel (2025) Evaluating antibiotic medications delivered through elastomeric devices in a paediatric population: a systematic review. Archives of Disease in Childhood. (doi:10.1136/archdischild-2025-328774).

Record type: Article

Abstract

Background: elastomeric devices (EDs) allow infusion of antibiotic via an intravenous catheter over 24 hours, supporting outpatient parenteral antimicrobial therapy. We conducted a systematic review of these devices in a paediatric population.

Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was used to review studies assessing antibiotic delivery through EDs in a paediatric population (0–21 years). Medline, Embase, CINAHL, PubMed, The Cochrane Clinical Trials Library, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform were searched.

Results: after deduplication, 1789 titles and abstracts were screened; 45 underwent full-text review and nine were suitable for qualitative synthesis. 567 patients were treated in 657 episodes. 14 different antibiotics and aciclovir were delivered through EDs, primarily 24-hour infusions. Median treatment duration was 10 to 15 days. A variety of infections were treated (mostly infective exacerbations of cystic fibrosis (CF), bone/joint infection). Efficacy data were limited; two studies demonstrated non-inferiority of antibiotic therapy via ED for CF patients compared with conventional infusion pumps. In another study, only two patients (6%) experienced treatment failure. Few adverse events were reported: 1 of 34 patients (3%) experienced ED failure due to misplacement of the central line; one case of antibiotic crystallisation.

Conclusion: EDs have been used for a range of antimicrobial agents in children, in the treatment of a variety of infections, mostly in CF patients, and few adverse events were reported. Further studies should concentrate on new patient groups, and specific information about safety and cost effectiveness of ED in children is required.

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More information

Accepted/In Press date: 12 November 2025
e-pub ahead of print date: 4 December 2025

Identifiers

Local EPrints ID: 510108
URI: http://eprints.soton.ac.uk/id/eprint/510108
ISSN: 0003-9888
PURE UUID: 8c9c83e7-7c2f-499c-8219-5b04af5e58f8
ORCID for Saul N. Faust: ORCID iD orcid.org/0000-0003-3410-7642

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Date deposited: 17 Mar 2026 18:02
Last modified: 18 Mar 2026 02:41

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Contributors

Author: Lee Shipman
Author: Vissagan Sankaranarayanan
Author: Abhishek Agarwal
Author: Jerry Chacko
Author: Amandine Charras
Author: Violet Swain
Author: Francesca Sposito
Author: Octavio Aragon
Author: David Porter
Author: Sanjay Valabh Patel
Author: Helen Green
Author: Saul N. Faust ORCID iD
Author: Penelope A. Bryant
Author: Barry Pizer
Author: Daniel Hawcutt

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