title: Pharmacokinetics of oral vs. intravenous dexamethasone in patients hospitalized with community-acquired pneumonia.
abstract: OBJECTIVE
  The use of corticosteroids as adjunctive therapy might be effective in patients with community-acquired pneumonia (CAP). Oral administration of dexamethasone is a practical and safer alternative to the intravenous route. Since patients hospitalized with pneumonia might have delayed gastric emptying, this study explored systemic exposure in terms of area under the concentration-time curve (AUC) of oral dexamethasone in patients hospitalized with CAP.
  
  
  METHODS
  In this randomized, open label study, 30 patients admitted with CAP were randomized to receive either 4 mg intravenous or 6 mg oral dexamethasone for 4 consecutive days. Serial blood samples were obtained before and after drug administration.
  
  
  RESULTS
  Median AUC to infinity was 626 μg l(-1)  h (IQR 401-1161) for the intravenous group and 774 μg l(-1)  h (IQR 618-1146) for the oral group. The AUC ratio of 6 mg oral and 4 mg intravenous dexamethasone was 1.22 (95% confidence interval (CI) 0.81, 1.82), which represents a bioavailability of 81% (95% CI 54, 121) after correction for differences in dexamethasone dose.
  
  
  CONCLUSIONS
  Bioavailability of oral dexamethasone in patients hospitalized with pneumonia is sufficient. This makes oral dexamethasone an appropriate alternative for intravenous administration in these patients.
authors.affiliation: Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Simone M C
authors.initials: SM
authors.lastname: Spoorenberg
authors.forename: Vera H M
authors.initials: VH
authors.lastname: Deneer
authors.forename: Jan C
authors.initials: JC
authors.lastname: Grutters
authors.forename: Astrid E
authors.initials: AE
authors.lastname: Pulles
authors.forename: G P Paul
authors.initials: GP
authors.lastname: Voorn
authors.forename: Ger T
authors.initials: GT
authors.lastname: Rijkers
authors.forename: Willem Jan W
authors.initials: WJ
authors.lastname: Bos
authors.forename: Ewoudt M W
authors.initials: EM
authors.lastname: van de Garde
mesh_terms: D000284:Administration, Oral; D000368:Aged; D001682:Biological Availability; D017714:Community-Acquired Infections / Q000097:blood* / Q000188:drug therapy*; D003907:Dexamethasone / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D006760:Hospitalization; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D011014:Pneumonia / Q000097:blood* / Q000188:drug therapy*
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone
keywords: CAP; bioavailability; community-acquired pneumonia; dexamethasone; intravenous; oral