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Penicillin G Treatment in Infective Endocarditis Patients - Does Standard Dosing Result in Therapeutic Plasma Concentrations?
- Source :
- Basic & Clinical Pharmacology & Toxicology; Feb2017, Vol. 120 Issue 2, p179-186, 8p
- Publication Year :
- 2017
-
Abstract
- Penicillin G is frequently used to treat infective endocarditis ( IE) caused by streptococci, penicillin-susceptible staphylococci and enterococci. Appropriate antibiotic exposure is essential for survival and reduces the risk of complications and drug resistance development. We determined penicillin G plasma concentration [p-penicillin] once weekly in 46 IE patients. The aim was to evaluate whether penicillin G 3 g every 6 hr (q6 h) resulted in therapeutic concentrations and to analyse potential factors that influence inter- and intra-individual variability, using linear regression and a random coefficient model. [P-penicillin] at 3 hr and at 6 hr was compared with the minimal inhibitory concentration ( MIC) of the bacteria isolated from blood cultures to evaluate the following PK/ PD targets: 50% fT > MIC and 100% fT > MIC. [P-penicillin] varied notably between patients and was associated with age, weight, p-creatinine and estimated creatinine clearance (eCLcr). Additionally, an increase in [p-penicillin] during the treatment period showed strong correlation with age, a low eCLcr, a low weight and a low p-albumin. Of the 46 patients, 96% had [p-penicillin] that resulted in 50% fT > MIC, while 71% had [p-penicillin] resulting in 100% fT > MIC. The majority of patients not achieving the 100% fT > MIC target were infected with enterococci. Streptococci and staphylococci isolated from blood cultures were highly susceptible to penicillin G. Our results suggest that penicillin G 3 g q6 h is suitable to treat IE caused by streptococci and penicillin-susceptible staphylococci, but caution must be taken when the infection is caused by enterococci. When treating enterococci, therapeutic drug monitoring should be applied to optimize penicillin G dosing and exposure. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 17427835
- Volume :
- 120
- Issue :
- 2
- Database :
- Complementary Index
- Journal :
- Basic & Clinical Pharmacology & Toxicology
- Publication Type :
- Academic Journal
- Accession number :
- 120845995
- Full Text :
- https://doi.org/10.1111/bcpt.12661