Personalized ß-lactam dosing in patients with coronavirus disease 2019 (COVID-19) and pneumonia: a retrospective analysis on pharmacokinetics and pharmacokinetic target attainment
Pathophysiological changes are important risk factors for critically ill patients with pneumonia manifesting sub-therapeutic antibiotic exposures during empirical treatment. The effect of coronavirus disease 2019 (COVID-19) on antibiotic dosing requirements is uncertain. We aimed to determine the ef...
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| Main Authors: | , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
2021
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| In: |
Medicine
Year: 2021, Volume: 100, Issue: 22, Pages: 1-7 |
| ISSN: | 1536-5964 |
| DOI: | 10.1097/MD.0000000000026253 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1097/MD.0000000000026253 Verlag, lizenzpflichtig, Volltext: https://journals.lww.com/md-journal/Fulltext/2021/06040/Personalized___lactam_dosing_in_patients_with.98.aspx 
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| Author Notes: | Ute Chiriac, Otto R. Frey, Anka C. Roehr, Andreas Koeberer, Patrick Gronau, Thomas Fuchs, Jason A. Roberts, Alexander Brinkmann |
| Summary: | Pathophysiological changes are important risk factors for critically ill patients with pneumonia manifesting sub-therapeutic antibiotic exposures during empirical treatment. The effect of coronavirus disease 2019 (COVID-19) on antibiotic dosing requirements is uncertain. We aimed to determine the effect of COVID-19 on ß-lactam pharmacokinetics (PK) and PK target attainment in critically ill patients with a personalized dosing strategy. - Retrospective, single-center analysis of COVID-19 ± critically ill patients with pneumonia (community-acquired pneumonia or hospital-acquired pneumonia) who received continuous infusion of a ß-lactam antibiotic with dosing personalized through dosing software and therapeutic drug monitoring. A therapeutic exposure was defined as serum concentration between (css) 4 to 8 times the EUCAST non-species related breakpoint). - Data from 58 patients with pneumonia was analyzed. Nineteen patients were tested COVID-19-positive before the start of the antibiotic therapy for community-acquired pneumonia or hospital-acquired pneumonia. Therapeutic exposure was achieved in 71% of COVID-19 patients (68% considering all patients). All patients demonstrated css above the non-species-related breakpoint. Twenty percent exceeded css above the target range (24% of all patients). The median ß-lactam clearance was 49% compared to ß-lactam clearance in a standard patient without a significant difference regarding antibiotic, time of sampling or present COVID-19 infection. Median daily doses were 50% lower compared to standard bolus dosing. - COVID-19 did not significantly affect ß-lactam pharmacokinetics in critically ill patients. Personalized ß-lactam dosing strategies were safe in critically ill patients and lead to high PK target attainment with less resources. |
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| Item Description: | Gesehen am 30.07.2021 |
| Physical Description: | Online Resource |
| ISSN: | 1536-5964 |
| DOI: | 10.1097/MD.0000000000026253 |