title: Intraosseous and intravenous administration of antibiotics yields comparable plasma concentrations during experimental septic shock.
abstract: BACKGROUND
  We aimed to investigate whether comparable antibiotic concentrations could be reached with intraosseous and intravenous administration during septic shock.
  
  
  METHODS
  In this randomized, prospective experimental study conducted at an animal research laboratory at the University Hospital of Uppsala, eight anesthetized pigs, weighing 21.2 to 29.1 kg (mean: 25.2 ± 2.3 kg), received endotoxin infusion at 4 μg/kg/h for 6 h. At the onset of clinical shock, alternatively after 3 h of endotoxemia, they received 75 mg/kg of cefotaxime and 7 mg/kg of gentamicin either in a proximal tibial intraosseous catheter or in a peripheral intravenous catheter. Mixed venous samples were taken after 5, 15, 30, 60, 120 and 180 min and analyzed for antibiotic concentrations.
  
  
  RESULTS
  For both antibiotics, plasma concentrations after intraosseous and intravenous administration followed similar curves throughout the observation period, and peak concentrations were comparable. Mean concentration area under the curve (AUC mg × h/l) for cefotaxime was 108.1 ± 19.5 after intraosseous and 116.5 ± 11.1 after intravenous administration; ratio 0.93, (95% CI 0.71-1.19). Mean AUC for gentamicin was 28.1 ± 6.8 for intraosseous and 32.2 ± 3.5 for intravenous administration; ratio 0.87 (95% CI 0.62-1.19).
  
  
  CONCLUSIONS
  In this porcine septic shock model, intraosseous and intravenous administration of gentamicin and cefotaxime yielded comparable concentrations. In an emergency, intraosseous administration of these antibiotics may be considered in severe infections when venous access is difficult.
authors.affiliation: Section of Anesthesiology & Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Strandberg
authors.forename: A
authors.initials: A
authors.lastname: Larsson
authors.forename: M
authors.initials: M
authors.lastname: Lipcsey
authors.forename: J
authors.initials: J
authors.lastname: Michalek
authors.forename: M
authors.initials: M
authors.lastname: Eriksson
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000097:blood* / Q000627:therapeutic use*; D004195:Disease Models, Animal; D017148:Infusions, Intraosseous; D007262:Infusions, Intravenous; D011446:Prospective Studies; D011897:Random Allocation; D012772:Shock, Septic / Q000097:blood* / Q000188:drug therapy*; D013552:Swine; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents