Abstract
Objective
To compare the pharmacokinetic parameters of sequential intravenous and subcutaneous teicoplanin in the plasma of surgical intensive care unit patients.
Design and setting
Prospective, randomized, crossover study in the surgical ICU of a university hospital.
Patients
Twelve patients with a suspected nosocomial infection, a serum albumin level higher than 10 g/l, body mass index less than 28 kg/m2, and estimated creatinine clearance higher than 70 ml/min.
Interventions
Teicoplanin was first administered intravenously as a loading dose of 6 mg/kg per 12 h for 48 h and then continued at a daily dose of 6 mg/kg. On the fourth day patients were randomized in two groups according to the order of the pharmacokinetic studies.
Measurements and results
Serial plasma samples were obtained to measure teicoplanin levels. Compared with a 30-min intravenous infusion the peak concentration of teicoplanin after a 30-min subcutaneous administration occurred later (median 7 h, range 5–18) and was lower (16 µg/ml, 9–31; vs. 73, 53–106). Despite large and unpredictable interindividual differences no significant differences between subcutaneous and intravenous administration were observed in: trough antibiotic concentrations (10 µg/ml, 6–24; vs. 9, 5–30), the area under the teicoplanin plasma concentration vs. time curves from 0 to 24 h (AUC0–24h; 309 µg/ml per minute, 180–640; vs. 369, 171–955), the proportion of the dosing interval during which the plasma teicoplanin concentration exceeded 10 µg/ml (96%, 0–100%; vs. 79%, 13–100%), and the ratio of AUC0–24h to 10 (77, 45–160; vs. 92, 43–239).
Conclusions
In critically ill patients without vasopressors a switch to the subcutaneous teicoplanin after an initial intravenous therapy seems to give comparable pharmacodynamic indexes of therapeutic success.
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References
Karchmer AW (2000) Nosocomial bloodstream infections: organisms, risk factors, and implications. Clin Infect Dis 31 Suppl 4:S139–S143
Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoine MH, Wolff M, Spencer RC, Hemmer M (1995) The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA 274:639–644
Johnson AP, James D, Livermore DM (1999) Increasing prevalence of methicillin resistance amongst Staphylococcus aureus blood culture isolates. J Antimicrob Chemother 43:160
Struelens MJ (1998) The epidemiology of antimicrobial resistance in hospital acquired infections: problems and possible solutions. BMJ 317:652–654
Wood MJ (1996) The comparative efficacy and safety of teicoplanin and vancomycin. J Antimicrob Chemother 37:209–222
Antony KK, Lewis EW, Kenny MT, Dulworth JK, Brackman MB, Kuzma R, Yuh L, Eller MG, Thompson GA (1991) Pharmacokinetics and bioavailability of a new formulation of teicoplanin following intravenous and intramuscular administration to humans. J Pharm Sci 80:605–607
Cockcroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16:31–41
Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963
Brogden RN, Peters DH (1994) Teicoplanin. A reappraisal of its antimicrobial activity, pharmacokinetic properties and therapeutic efficacy. Drugs 47:823–854
Lortholary O, Tod M, Rizzo N, Padoin C, Biard O, Casassus P, Guillevin L, Petitjean O (1996) Population pharmacokinetic study of teicoplanin in severely neutropenic patients. Antimicrob Agents Chemother 40:1242–1247
Charbonneau P, Harding I, Garaud JJ, Aubertin J, Brunet F, Domart Y (1994) Teicoplanin: a well-tolerated and easily administered alternative to vancomycin for gram-positive infections in intensive care patients. Intensive Care Med 20 Suppl 4:S35–S42
Amrein C, Hillaire-Buys D, Guillemain R, Taburet AM, Vulser C, Despeaux E, Singlas E (1992) Teicoplanin can be administered by subcutaneous route. 32e Interscience Conference on Antimicrobial Agents and Chemotherapy, Anaheim
van Dalen R, Vree TB (1990) Pharmacokinetics of antibiotics in critically ill patients. Intensive Care Med16 [Suppl 3]:S235–S238
Assandri A, Bernareggi A (1987) Binding of teicoplanin to human serum albumin. Eur J Clin Pharmacol 33:191–195
Mimoz O, Binter V, Jacolot A, Edouard AR, Tod M, Petitjean O, Samii K (1998) Pharmacokinetics and absolute bioavailability of ciprofloxacin administered through a nasogastric tube with continuous enteral feeding to critically ill patients. Intensive Care Med 24:1047–1051
Jacolot A, Incagnoli P, Edouard AR, Tod M, Petitjean O, Samii K, Mimoz O (1999) Pharmacokinetics of cefpirome during the posttraumatic systemic inflammatory response syndrome. Intensive Care Med 25:486–491
Mimoz O, Soreda S, Padoin C, Tod M, Petitjean O, Benhamou D (2000) Ceftriaxone pharmacokinetics during iatrogenic hydroxyethyl starch-induced hypoalbuminemia: a model to explore the effects of decreased protein binding capacity on highly-bound drugs. Anesthesiology 93:735–743
Mimoz O, Schaeffer V, Incagnoli P, Louchahi K, Edouard A, Petitjean O, Tod M (2001) Amoxicillin-clavulanate pharmacokinetics during post-traumatic hemorrhagic shock. Crit Care Med 29:1350–1355
Craig WA (1998) Pharmacokinetic/pharmacodynamic parameters: rationale for antimicrobial dosing in mice and men. Clin Infect Dis 26:1–12
Amrein C, Atlani C, Ghirardi L (1997) Teicoplanine par voie sous-cutanée: résultats d'une étude multicentrique rétrospective. 17e Réunion Interdisciplinaire de Chimiothérapie Anti-Infectieuse, Paris, France
Tegeder I, Schmidtko A, Brautigam L, Kirschbaum A, Geisslinger G, Lotsch J (2002) Tissue distribution of imipenem in critically ill patients. Clin Pharmacol Ther 71:325–333
Joukhadar C, Frossard M, Mayer BX, Brunner M, Klein N, Siostrzonek P, Eichler HG, Muller M (2001) Impaired target site penetration of beta-lactams may account for therapeutic failure in patients with septic shock. Crit Care Med 29:385–391
Lesne-Hulin A, Bourget P, Le Bever H, Ainaud P, Carsin H (1997) Therapeutic monitoring of teicoplanin in a severely burned patient. Ann Fr Anesth Reanim 16:374–347
Wilson AP (2000) Clinical pharmacokinetics of teicoplanin. Clin Pharmacokinet 39:167–183
Dorffler-Melly J, de Jonge E, Pont AC, Meijers J, Vroom MB, Buller HR, Levi M (2002) Bioavailability of subcutaneous low-molecular-weight heparin to patients on vasopressors. Lancet 359:849–850
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Barbot, A., Venisse, N., Rayeh, F. et al. Pharmacokinetics and pharmacodynamics of sequential intravenous and subcutaneous teicoplanin in critically ill patients without vasopressors. Intensive Care Med 29, 1528–1534 (2003). https://doi.org/10.1007/s00134-003-1859-z
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DOI: https://doi.org/10.1007/s00134-003-1859-z