Decreased risk of underdosing with continuous infusion versus intermittent administration of cefotaxime in patients with sickle cell disease and acute chest syndrome.

Autor: Razazi K; AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France.; Université Paris Est Créteil, INSERM, IMRB, Créteil, F-94010, France.; Université Paris Est Créteil, CARMAS, Créteil, F-94010, France., Berti E; AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France.; Université Paris Est Créteil, CARMAS, Créteil, F-94010, France., Cecchini J; AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France.; Université Paris Est Créteil, CARMAS, Créteil, F-94010, France.; Hôpital Intercommunal de Créteil, Service de Réanimation et Surveillance Continue Adulte, 94000, Créteil, France., Carteaux G; AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France.; Université Paris Est Créteil, INSERM, IMRB, Créteil, F-94010, France.; Université Paris Est Créteil, CARMAS, Créteil, F-94010, France., Habibi A; Université Paris Est Créteil, INSERM, IMRB, Créteil, F-94010, France.; AP-HP, Hôpitaux Universitaires Henri-Mondor, Centre de Référence de la Drépanocytose, Créteil, France., Bartolucci P; Université Paris Est Créteil, INSERM, IMRB, Créteil, F-94010, France.; AP-HP, Hôpitaux Universitaires Henri-Mondor, Centre de Référence de la Drépanocytose, Créteil, France., Arrestier R; AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France.; Université Paris Est Créteil, INSERM, IMRB, Créteil, F-94010, France.; Université Paris Est Créteil, CARMAS, Créteil, F-94010, France., Gendreau S; AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France.; Université Paris Est Créteil, INSERM, IMRB, Créteil, F-94010, France.; Université Paris Est Créteil, CARMAS, Créteil, F-94010, France., de Prost N; AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France.; Université Paris Est Créteil, INSERM, IMRB, Créteil, F-94010, France.; Université Paris Est Créteil, CARMAS, Créteil, F-94010, France., Hulin A; AP-HP, Hôpitaux Universitaires Henri Mondor, Service de Biochimie, Créteil, 94010 France., Dessap AM; AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France.; Université Paris Est Créteil, INSERM, IMRB, Créteil, F-94010, France.; Université Paris Est Créteil, CARMAS, Créteil, F-94010, France.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2024 Apr 18; Vol. 19 (4), pp. e0302298. Date of Electronic Publication: 2024 Apr 18 (Print Publication: 2024).
DOI: 10.1371/journal.pone.0302298
Abstrakt: Objective: Underdosing of antibiotics is common in patients with sickle cell disease (SCD). We hypothesized that in critically-ill patients with SCD receiving cefotaxime during acute chest syndrome, the continuous infusion may outperform the intermittent administration in achieving pharmacokinetic/pharmacodynamic targets.
Design: Prospective before-after study.
Settings: Intensive-care unit of a French teaching hospital and sickle cell disease referral center.
Patients: Sixty consecutive episodes of severe acute chest syndrome in 58 adult patients with sickle cell disease.
Interventions: Patients were treated with intermittent administration during the first period (April 2016 -April 2018) and with continuous infusion during the second period (May 2018 -August 2019).
Measurements and Main Results: We included 60 episodes of acute chest syndrome in 58 patients (29 [25-34] years, 37/58 (64%) males). Daily dose of cefotaxime was similar between groups (59 [48-88] vs. 61 [57-64] mg/kg/day, p = 0.84). Most patients (>75%) presented a glomerular hyperfiltration with no difference between groups (p = 0.25). More patients had a cefotaxime trough level ≥2 mg/L with continuous infusion than intermittent administration: 28 (93%) vs. 5 (16%), p<0.001. The median residual concentration was higher in the continuous infusion than intermittent administration group: 10.5 [7.4-13.3] vs. 0 [0-0] mg/L, p<0.001. No infection relapse was observed in the entire cohort. Hospital length of stay was similar between groups.
Conclusion: As compared to intermittent administration, continuous infusion of cefotaxime maximizes the pharmacokinetic/pharmacodynamic parameters in patients with SCD. The clinical outcome did not differ between the two administration methods; however, the study was underpowered to detect such a difference.
Competing Interests: NO authors have competing interests.
(Copyright: © 2024 Razazi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje