Pharmacokinetics and protein binding of cefazolin in morbidly obese patients
| Autor: | Marinus J. Wiezer, Simone van Kralingen, B. Vlaminckx, Vera H.M. Deneer, Catherijne A. J. Knibbe, Jeroen Diepstraten, Bert van Ramshorst, Margot Taks, Eric P.A. van Dongen, Ewoudt M W van de Garde |
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| Rok vydání: | 2010 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.drug_class Antibiotics Population Cefazolin Bariatric Surgery Gastroenterology Pharmacokinetics Interquartile range Internal medicine medicine Humans Pharmacology (medical) Prospective Studies Prospective cohort study education Pharmacology Volume of distribution education.field_of_study business.industry Age Factors General Medicine Anti-Bacterial Agents Obesity Morbid Anesthesia Injections Intravenous Female business Body mass index medicine.drug Protein Binding |
| Zdroj: | European journal of clinical pharmacology. 67(10) |
| ISSN: | 1432-1041 |
| Popis: | The aim of this study was to assess the pharmacokinetics and protein binding of cefazolin in morbidly obese patients undergoing bariatric surgery, to study the influence of bodyweight measures and age on pharmacokinetic parameters and to evaluate unbound cefazolin concentrations over time in this population.Twenty morbidly obese patients (bodyweight 112-260 kg, body mass index 38-79 kg m(-2)) were studied following the administration of cefazolin 2 g at induction of anaesthesia. Blood samples were collected up to 4 h post-dosing to determine total and unbound plasma cefazolin concentrations. Non-compartmental pharmacokinetic data analysis was performed.Cefazolin clearance was 4.2 ± 1.0 L h(-1) (mean ± standard deviation) and showed a negative correlation with age (p = 0.003) but not with bodyweight measures (p 0.05). Volume of distribution was 13.0 ± 3.1 L and correlated positively with bodyweight measures (p ≤ 0.001). Saturable protein binding was observed with a median protein binding of 79% (interquartile range 74-82), which proved similar to reported protein binding in non-obese patients. In all patients, unbound cefazolin concentrations remained above 1 mg L(-1) (minimal inhibitory concentration for 90% (MIC(90)) of methicillin-sensitive isolates of Staphylococcus aureus in Europe) until 4 h post-dosing.Younger age--and not bodyweight--was significantly associated with higher cefazolin clearance. However, as in all patients with bodyweights up to 260 kg, unbound plasma cefazolin concentrations remained above 1 mg L(-1) until 4 h after the intravenous administration of a 2-g dose. As such, re-dosing within 4 h or dosing with another antibiotic class should only be considered in the case of a higher MIC(90) of the local isolates. |
| Databáze: | OpenAIRE |
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