Is the subcutaneous route an alternative for administering ertapenem to older patients? PHACINERTA study.

Autor:	Roubaud Baudron C; CHU Bordeaux, Pôle de Gérontologie Clinique, F-33000 Bordeaux, France.; Univ. Bordeaux, INSERM UMR 1053, BaRITOn, F-33000 Bordeaux, France., Legeron R; CHU Bordeaux, Service Pharmacie à Usage Intérieur, département de Pharmacie Clinique, F-33000 Bordeaux, France., Ollivier J; CHU Bordeaux, Service Pharmacie à Usage Intérieur, département de Pharmacie Clinique, F-33000 Bordeaux, France., Bonnet F; CHU Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Hôpital Sain-André, F-33000 Bordeaux, France., Greib C; CHU Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Hôpital Haut Lévêque, F-33000 Bordeaux, France., Guerville F; CHU Bordeaux, Pôle de Gérontologie Clinique, F-33000 Bordeaux, France., Cazanave C; CHU Bordeaux, Service des Maladies Infectieuses et Tropicales, Hôpital Pellegrin, F-33000 Bordeaux, France.; Univ. Bordeaux, INRA, USC EA 3671, Infections humaines à mycoplasmes et à chlamydiae, F-33000 Bordeaux, France., Kobeh D; CHU Bordeaux, Pôle de Gérontologie Clinique, F-33000 Bordeaux, France., Cressot V; CHU Bordeaux, Pôle de Gérontologie Clinique, F-33000 Bordeaux, France., Moneger N; CHU Bordeaux, Pôle de Gérontologie Clinique, F-33000 Bordeaux, France., Videau MN; CHU Bordeaux, Pôle de Gérontologie Clinique, F-33000 Bordeaux, France., Thiel E; CHU Bordeaux, Pôle de Gérontologie Clinique, F-33000 Bordeaux, France., Foucaud C; CHU Bordeaux, Pôle de Gérontologie Clinique, F-33000 Bordeaux, France., Lafargue A; CHU Bordeaux, Pôle de Gérontologie Clinique, F-33000 Bordeaux, France., de Thezy A; CHU Bordeaux, Pôle de Gérontologie Clinique, F-33000 Bordeaux, France., Durrieu J; CHU Bordeaux, Pôle de Gérontologie Clinique, F-33000 Bordeaux, France., Bourdel Marchasson I; CHU Bordeaux, Pôle de Gérontologie Clinique, F-33000 Bordeaux, France.; Univ. Bordeaux, CNRS UMR 5536 RMSB, F-33000 Bordeaux, France., Pinganaud G; CHU Bordeaux, Pôle de Gérontologie Clinique, F-33000 Bordeaux, France., Breilh D; CHU Bordeaux, Service Pharmacie à Usage Intérieur, département de Pharmacie Clinique, F-33000 Bordeaux, France.; Univ. Bordeaux, INSERM UMR 1034, Pharmacokinetics and Pharmacodynamics (PK/PD) Group, F-33000 Bordeaux, France.
Jazyk:	angličtina
Zdroj:	The Journal of antimicrobial chemotherapy [J Antimicrob Chemother] 2019 Dec 01; Vol. 74 (12), pp. 3546-3554.
DOI:	10.1093/jac/dkz385
Abstrakt:	Background: Antibiotic administration by subcutaneous (SC) injection is common practice in French geriatric wards as an alternative to the intravenous (IV) route, but few pharmacokinetic/pharmacodynamic data are available. Ertapenem is useful for the treatment of infections with ESBL-producing enterobacteria. Objectives: To report and compare ertapenem pharmacokinetic data between IV and SC routes in older persons. Methods: Patients >65 years of age receiving ertapenem (1 g once daily) for at least 48 h (IV or SC, steady-state) were prospectively enrolled. Total ertapenem concentrations [residual (C0), IV peak (C0.5) and SC peak (C2.5)] were determined by UV HPLC. Individual-predicted AUC0-24 values were calculated and population pharmacokinetic analyses were performed. Using the final model, a Monte Carlo simulation involving 10 000 patients evaluated the influence of SC or IV administration on the PTA. Tolerance to ertapenem and recovery were also monitored. ClinicalTrials.gov identifier: NCT02505386. Results: Ten (mean ± SD age=87±7 years) and 16 (age=88±5 years) patients were included in the IV and SC groups, respectively. The mean C0 and C2.5 values were not significantly different between the IV and SC groups (C0=12±5.9 versus 12±7.4 mg/L, P=0.97; C2.5=97±42 versus 67±41 mg/L, P=0.99). The mean C0.5 was higher in the IV group compared with the SC group (C0.5=184±90 versus 51±66 mg/L, P=0.001). The mean individual AUCs (1126.92±334.99 mg·h/L for IV versus 1005.3±266.0 mg·h/L for SC, P=0.38) and PTAs were not significantly different between groups. No severe antibiotic-related adverse effects were noted. Conclusions: SC administration of ertapenem is an alternative to IV administration in older patients. (© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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