Population Pharmacokinetics of Cefoxitin Administered for Pediatric Cardiac Surgery Prophylaxis
| Autor: | Ricci, Z., Benegni, S., Cies, J. J., Marinari, E., Haiberger, R., Garisto, C., Rizza, A., Giorni, C., Di Chiara, L., Arpicco, S., Muntoni, E., Ferrari, F., Milla, P. |
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| Rok vydání: | 2020 |
| Předmět: |
Microbiology (medical)
Cardiopulmonary bypass Cefoxitin Pediatric cardiac surgery Pharmacodynamics Pharmacokinetics Adolescent Population Microbial Sensitivity Tests law.invention 03 medical and health sciences Surgical prophylaxis 0302 clinical medicine Bolus (medicine) law 030225 pediatrics Humans Medicine Prospective Studies 030212 general & internal medicine Cardiac Surgical Procedures Child education Volume of distribution education.field_of_study Models Statistical business.industry Infant Newborn Infant Antibiotic Prophylaxis Anti-Bacterial Agents surgical procedures operative Infectious Diseases Child Preschool Anesthesia Pediatrics Perinatology and Child Health business Monte Carlo Method medicine.drug |
| Zdroj: | Pediatric Infectious Disease Journal. 39:609-614 |
| ISSN: | 0891-3668 |
| DOI: | 10.1097/inf.0000000000002635 |
| Popis: | BACKGROUND Available data about pharmacokinetics (PK) of antimicrobials administered as surgical prophylaxis to children undergoing cardiac surgery with cardiopulmonary bypass (CPB) showed that drug concentrations during CPB may be supra or subtherapeutic. The aim of this study was to determine the population PK and pharmacodynamic target attainment (PTA) of cefoxitin during pediatric CPB surgery. METHODS A prospective interventional study was conducted. Cefoxitin (40 mg/kg, up to max 1000 mg) was administered before skin incision. Blood samples were obtained in the operatory room throughout surgery. Population PK, PTA, and safety of cefoxitin were evaluated in neonates, infants, children 10 years old. RESULTS Forty patients were enrolled. Cefoxitin levels correlated with time from bolus administration (r = -0.6, P = 0.0001) and, after 240 minutes from bolus, drug values below the target (8 mg/L) were shown. Cefoxitin concentrations were best described by a one-compartment model with first order elimination. A significant relationship was identified between body weight, age, body mass index, and serum creatinine on drug clearance and age, body weight, and body mass index on cefoxitin volume of distribution. The PTA for free drug concentration being above the minimum inhibitory concentration of 8 mg/L for at least 240 minutes was >90% in all age groups except in patients >10 years of age (PTA = 62%). CONCLUSIONS Cefoxitin PK appears to be significantly influenced by CPB with generally reduced drug clearance. The PTA was adequately achieved in the majority of patients except in patients >10 years old or longer surgeries. |
| Databáze: | OpenAIRE |
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