Use of high-performance liquid chromatography (HPLC) to monitor beta-lactam plasma concentrations during the treatment of endocarditis.
Guidelines recommend high doses of beta-lactams for the therapy of endocarditis. This report describes a retrospective study of 15 endocarditis patients (median age 64 years), treated according to guidelines, whose beta-lactam trough plasma concentrations were measured with high-performance liquid chromatography because of tolerance or efficacy concerns. For amoxycillin, the mean level was 86.8 mg/L (range: 30-212 mg/L); five (45%) patients had concentrations > 1000 x MIC. For cloxacillin, the mean level was 47.9 mg/L (range: 16.7-104 mg/L). The consequences of high and unpredicted beta-lactam trough plasma concentrations for a prolonged period have not yet been thoroughly evaluated.
Tattevin
P
P
Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France. pierre.tattevin@chu-rennes.fr
Tribut
O
O
Arvieux
C
C
Dupont
M
M
Flicoteaux
R
R
Desbordes
L
L
Le Tulzo
Y
Y
Michelet
C
C
D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000493:pharmacokinetics* / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics* / Q000627:therapeutic use; D002851:Chromatography, High Pressure Liquid; D003023:Cloxacillin / Q000493:pharmacokinetics* / Q000627:therapeutic use; D016903:Drug Monitoring / Q000379:methods*; D004697:Endocarditis, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006095:Gram-Positive Cocci / Q000187:drug effects; D006801:Humans; D041121:Klebsiella oxytoca / Q000187:drug effects; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D047090:beta-Lactams / Q000493:pharmacokinetics* / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D000658:Amoxicillin; D003023:Cloxacillin