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Master Thesis

Comparaison pharmacologique des administrations continue et intermittente de cloxacilline par voie intraveineuse dans les infections ostéo-articulaires à Staphylococcus aureus

Abstract : Introduction : The time-dependant antibiotic cloxacillin is the gold standard treatment for the early phase of methicillin-susceptible Staphylococcus aureus bone and joint infections (BJI). Continuous infusion of some β-lactams is associated with pharmacokinetic/pharmacodynamic parameters improvement and more data are required to allow the extended use of cloxacilline through continuous infusion. We aimed to compare continuous and intermittent infusion of cloxacillin using in vivo pharmacology endpoints in patients presenting methicillin-susceptible S. aureus BJI.
Methods : We conducted a prospective open-label trial to compare plasma concentrations of cloxacillin in each patient with either two 12-hour perfusions of 75 mg/kg per day (continuous period) or with four one-hour perfusions of 37,5 mg/kg daily (intermittent period). Pharmacologic assays were performed at H1, H2, H3, H4 and H6 during intermittent period and at H1, H6 and H11 during continuous period. Free drug concentration was considered for the analysis. We also assessed the patient’s comfort and the nurses’ preference for each period. Free drug concentration was considered for the analysis.
Results : Eleven patients were analyzed. Among seven patients with all data available, 70% f T>MIC was achieved for 100% during continuous period and 86% during intermittent period (p>0,999). 100% f T>MIC was achieved for 100% during continuous period and 29% during intermittent period (p=0,021). No specific side effect of continuous infusion was detected. Continuous infusion was preferred to intermittent by four out of nine patients (44,4%) and 12 nurses out of 20 (60%).
Conclusion : Continuous infusion provides higher plasmatic cloxacillin levels without specific side-effects. These results could allow its use in home-based care.
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Master Thesis
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Submitted on : Wednesday, October 30, 2019 - 6:09:16 PM
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Margaux Garzaro. Comparaison pharmacologique des administrations continue et intermittente de cloxacilline par voie intraveineuse dans les infections ostéo-articulaires à Staphylococcus aureus. Médecine humaine et pathologie. 2018. ⟨dumas-02340365⟩

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