Is the subcutaneous route an alternative for administering ertapenem to older patients? PHACINERTA study.
J Antimicrob Chemother
; 74(12): 3546-3554, 2019 12 01.
Article
in En
| MEDLINE
| ID: mdl-31730164
ABSTRACT
BACKGROUND:
Antibiotic administration by subcutaneous (SC) injection is common practice in French geriatric wards as an alternative to the intravenous (IV) route, but few pharmacokinetic/pharmacodynamic data are available. Ertapenem is useful for the treatment of infections with ESBL-producing enterobacteria.OBJECTIVES:
To report and compare ertapenem pharmacokinetic data between IV and SC routes in older persons.METHODS:
Patients >65 years of age receiving ertapenem (1 g once daily) for at least 48 h (IV or SC, steady-state) were prospectively enrolled. Total ertapenem concentrations [residual (C0), IV peak (C0.5) and SC peak (C2.5)] were determined by UV HPLC. Individual-predicted AUC0-24 values were calculated and population pharmacokinetic analyses were performed. Using the final model, a Monte Carlo simulation involving 10 000 patients evaluated the influence of SC or IV administration on the PTA. Tolerance to ertapenem and recovery were also monitored. ClinicalTrials.gov identifier NCT02505386.RESULTS:
Ten (mean ± SD age=87±7 years) and 16 (age=88±5 years) patients were included in the IV and SC groups, respectively. The mean C0 and C2.5 values were not significantly different between the IV and SC groups (C0=12±5.9 versus 12±7.4 mg/L, P=0.97; C2.5=97±42 versus 67±41 mg/L, P=0.99). The mean C0.5 was higher in the IV group compared with the SC group (C0.5=184±90 versus 51±66 mg/L, P=0.001). The mean individual AUCs (1126.92±334.99 mg·h/L for IV versus 1005.3±266.0 mg·h/L for SC, P=0.38) and PTAs were not significantly different between groups. No severe antibiotic-related adverse effects were noted.CONCLUSIONS:
SC administration of ertapenem is an alternative to IV administration in older patients.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Ertapenem
/
Injections, Subcutaneous
/
Anti-Bacterial Agents
Type of study:
Health_economic_evaluation
/
Observational_studies
/
Prognostic_studies
Limits:
Aged
/
Aged80
/
Female
/
Humans
/
Male
Country/Region as subject:
Europa
Language:
En
Journal:
J Antimicrob Chemother
Year:
2019
Document type:
Article
Affiliation country:
France