title: [Utilization of the knowledge of antibiotic pharmacokinetics in the treatment of thoracic empyema].
abstract: OBJECTIVE
  To confirm whether respecting the pharmacokinetics of beta-lactam antibiotics in the treatment of thoracic empyema substantially influences the lengths of antibiotic therapy, thoracic drainage and hospital stay.
  
  
  METHODS
  During a 30-month period, we compared two groups of patients treated for empyema, one with the standard administration of antibiotics, i.e. a 30-minute bolus, the other with the administration infusion time prolonged to 2 to 3 hours. We observed how rapidly inflammatory markers decreased (C-reactive protein, leukocytes), the lengths of thoracic drainage, antibiotic administration and hospital stay. The results were statistically compared.
  
  
  RESULTS
  The study involved 58 patients with the average age of 57 years, the majority of whom were men (50). The empyema aetiology was mostly parapneumonic. The results of primary cultivation were dominated by Gram-positive cocci and anaerobes. Gram-negative bacteria, as well as fungi, were mainly cultured as secondary hospital microflora. Both groups were comparable as to the size, age distribution, male to female ratio and microbiological spectrum of the cultured pathogens. Already the fourth postoperative day, statistically significant difference occurred in the C-reactive protein level and white cell count. The lengths of chest drainage, administration of antibiotics and hospital stay were 1 to 2 days shorter in the latter group. However, the decrease was not statistically significant.
  
  
  CONCLUSIONS
  The prolongation of antibiotic administration infusion time contributed to faster inflammation regression, shorter antibiotic therapy and thus shorter hospital stay without increased costs. Although the aforementioned parameters were not statistically significant, we consider any shortening of antibiotic administration time and hospital stay to be beneficial for patients. The approach should be recommended for clinical practice, especially in the treatment of severe infections.
authors: Department of Surgery, University Hospital Brno and Medical Faculty, Masaryk University Brno, Czech Republic. ihanke@fnbrno.cz
authors: Ivo
authors: I
authors: Hanke
authors: Markéta
authors: M
authors: Hanslianová
authors: Petr
authors: P
authors: Kysela
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics* / Q000627:therapeutic use; D016724:Empyema, Pleural / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D047090:beta-Lactams / Q000493:pharmacokinetics / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams