首页|Evaluation of total body weight and body mass index cut-offs for increased cefazolin dose for surgical prophylaxis

Evaluation of total body weight and body mass index cut-offs for increased cefazolin dose for surgical prophylaxis

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  • NSTL
  • Elsevier
French and American guidelines recommend increased dosage regimens of cefazolin (CFZ) for surgical prophylaxis in patients with a body mass index (BMI) >= 35 kg/m(2) or with a total bodyweight (TBW) >= 120 kg. The objective of this study was to evaluate the accuracy of these cut-offs in identifying patients who require CFZ dose adjustment. A pharmacokinetic study was conducted in patients of varying TBW and BMI who received 2 g of CFZ intravenously for prophylaxis prior to digestive surgery. Adequacy of therapy, defined as a serum concentration of unbound CFZ (fCFZ) >= 4 mg/L, was evaluated 180 min (T-180) and 240 min (T-240) after the start of CFZ infusion. Possible factors associated with insufficient fCFZ levels were also assessed. A P-value of < 0.05 was considered statistically significant. A total of 63 patients were included in the study, categorised according to BMI (< 35 kg/m(2), 20 patients; and >= 35 kg/m(2), 43 patients) and TBW (< 120 kg, 41 patients; and >= 120 kg, 22 patients). All patients had adequate drug levels at T-180 but only 40/63 patients (63%) had adequate levels at T-240. At T-240, therapy was adequate in 15/20 patients (75%) and 25/43 patients (58%) with BMI < 35 kg/m(2) and >= 35 kg/m(2), respectively (P = 0.20), and in 28/41 patients (68%) and 12/22 patients (55%) with TBW < 120 kg and = 120 kg, respectively (P = 0.28). No factor associated with insufficient fCFZ was identified. In conclusion, current BMI and TBW cut-offs are poor indicators of which patients could benefit from increased CFZ dosage regimens. (C) 2016 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license.

ObesityNon-obese patientsbeta-Lactam antibioticsPharmacokineticsPharmacodynamics

Hites, Maya、Deprez, Guillaume、Wolff, Fleur、Ickx, Brigitte、Verleije, Anita、Closset, Jean、Loi, Patrizia、Prevost, Jessica、Taccone, Fabio S.、Racape, Judith、Cotton, Frederic、Jacobs, Frederique

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Univ Libre Bruxelles, CUB Erasme Hosp, Dept Infect Dis, Route Lennik 808, B-1070 Brussels, Belgium

Univ Libre Bruxelles, CUB Erasme Hosp, Dept Clin Chem, Brussels, Belgium

Univ Libre Bruxelles, CUB Erasme Hosp, Dept Anesthesiol, Brussels, Belgium

Univ Libre Bruxelles, CUB Erasme Hosp, Dept Digest Surg, Brussels, Belgium

Univ Libre Bruxelles, CUB Erasme Hosp, Dept Intens Care, Brussels, Belgium

Univ Libre Bruxelles, Sch Publ Hlth, Res Ctr Epidemiol Biostat & Clin Res, CUB Erasme, Brussels, Belgium

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2016

10.1016/j.ijantimicag.2016.08.019

International journal of antimicrobial agents

International journal of antimicrobial agents

ISTP
ISSN：0924-8579
年,卷(期)：2016.48(6)
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