title: Sugammadex is effective in reversing rocuronium in the presence of antibiotics.
abstract: BACKGROUND
  The effectiveness of sugammadex in reversing rocuronium-induced neuromuscular blockade (NMB) in the presence of drugs that may potentiate NMB remains to be fully established. The aim of this post-hoc analysis of data from a Phase III clinical trial (VISTA; NCT00298831) was to investigate the impact of antibiotics on recovery from rocuronium-induced NMB after administration of sugammadex for reversal, and compared the neuromuscular recovery in patients who received antibiotics preoperatively with those who did not.
  
  
  METHODS
  A Phase III, multicenter, open-label study designed to reflect potential use of sugammadex in clinical practice was conducted at 19 sites. Data obtained from patients who received antibiotics were compared with the cohort of patients who underwent the same protocol without antibiotics. Each subject received rocuronium 0.6 mg/kg for muscle relaxation, after which tracheal intubation was performed; patients were also permitted to receive maintenance doses of rocuronium 0.15 mg/kg to maintain the desired level of NMB throughout the operation, as required.. At least 15 min after the last rocuronium dose, patients received sugammadex 4.0 mg/kg for reversal. Neuromuscular monitoring was continued until a train-of-four (TOF) ratio of ≥0.9 was achieved or the anesthetic was discontinued.
  
  
  RESULTS
  The presence of antibiotics prior to the administration of sugammadex did not affect the recovery time from rocuronium-induced NMB when sugammadex 4.0 mg/kg was administered at least 15 min after the last dose of rocuronium. In the presence of antibiotics, the geometric mean (95% CI) time from administration of sugammadex 4.0 mg/kg to recovery of the TOF ratio to ≥0.9 was 1.6 (1.4-1.9) min (range: 0.7-10.5 min), compared with 2.0 (1.8-2.3) min (range: 0.7-22.3 min) for patients who did not receive antibiotics.
  
  
  CONCLUSIONS
  These findings suggest that prophylactic antibiotic use is unlikely to have a major impact on the recovery time from rocuronium-induced NMB with sugammadex reversal.
  
  
  BACKGROUND
  ClinicalTrials.gov Identifier: NCT00298831.
authors.affiliation: Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Hudson
authors.affiliation: MSD, Oss, The Netherlands.
authors.forename: Henk
authors.initials: H
authors.lastname: Rietbergen
authors.affiliation: Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Jacques E
authors.initials: JE
authors.lastname: Chelly
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000732:Androstanols / Q000037:antagonists & inhibitors*; D000762:Anesthesia Recovery Period; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D015331:Cohort Studies; D004347:Drug Interactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019148:Neuromuscular Blockade; D003473:Neuromuscular Nondepolarizing Agents / Q000037:antagonists & inhibitors*; D011292:Premedication; D000077123:Rocuronium; D000077122:Sugammadex; D055815:Young Adult; D047408:gamma-Cyclodextrins / Q000494:pharmacology*
chemical_list: D000732:Androstanols; D000900:Anti-Bacterial Agents; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D000077123:Rocuronium
keywords: Antibiotics; Neuromuscular blockade; Rocuronium; Sugammadex