[Utilization of the knowledge of antibiotic pharmacokinetics in the treatment of thoracic empyema].
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.
Hanke
Ivo
I
Department of Surgery, University Hospital Brno and Medical Faculty, Masaryk University Brno, Czech Republic. ihanke@fnbrno.cz
Hanslianová
Markéta
M
Kysela
Petr
P
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
D000900:Anti-Bacterial Agents; D047090:beta-Lactams