Continuous infusion of ticarcillin-clavulanate for home treatment of serious infections: clinical efficacy, safety, pharmacokinetics and pharmacodynamics

Munckhof, WJ, Carney, J, Neilson, G, Neilson, J, Carroll, J, McWhinney, B and Whitby, M (2005) Continuous infusion of ticarcillin-clavulanate for home treatment of serious infections: clinical efficacy, safety, pharmacokinetics and pharmacodynamics. International Journal of Antimicrobial Agents, 25 6: 514-522. doi:10.1016/j.ijantimicag.2005.02.008


Author Munckhof, WJ
Carney, J
Neilson, G
Neilson, J
Carroll, J
McWhinney, B
Whitby, M
Title Continuous infusion of ticarcillin-clavulanate for home treatment of serious infections: clinical efficacy, safety, pharmacokinetics and pharmacodynamics
Journal name International Journal of Antimicrobial Agents   Check publisher's open access policy
ISSN 0924-8579
Publication date 2005
Sub-type Article (original research)
DOI 10.1016/j.ijantimicag.2005.02.008
Volume 25
Issue 6
Start page 514
End page 522
Total pages 9
Editor A. M. Geddes
Place of publication Netherlands
Publisher Elsevier BV
Collection year 2005
Language eng
Subject C1
321010 Infectious Diseases
730101 Infectious diseases
Abstract Continuous infusion (CI) ticarcillin-clavulanate is a potential therapeutic improvement over conventional intermittent dosing because the major pharmacodynamic (PD) predictor of efficacy of beta-lactams is the time that free drug levels exceed the MIC. This study incorporated a 6-year retrospective arm evaluating efficacy and safety of CI ticarcillin-clavulanate in the home treatment of serious infections and a prospective arm additionally evaluating pharmacokinetics (PK) and PD. In the prospective arm, steady-state serum ticarcillin and clavulanate levels and MIC testing of significant pathogens were performed. One hundred and twelve patients (median age, 56 years) were treated with a CI dose of 9.3-12.4 g/day and mean CI duration of 18.0 days. Infections treated included osteomyelitis (50 patients), septic arthritis (6), cellulitis (17), pulmonary infections (12), febrile neutropenia (7), vascular infections (7), intra-abdominal infections (2), and Gram-negative endocarditis (2); 91/112 (81%) of patients were cured, 14 (13%) had partial response and 7 (6%) failed therapy. Nine patients had PICC line complications and five patients had drug adverse events. Eighteen patients had prospective PK/PD assessment although only four patients had sufficient data for a full PK/PD evaluation (both serum steady-state drug levels and ticarcillin and clavulanate MICs from a bacteriological isolate), as this was difficult to obtain in home-based patients, particularly as serum clavulanate levels were found to deteriorate rapidly on storage. Three of four patients with matched PK/PD assessment had free drug levels exceeding the MIC of the pathogen. Home Cl of ticarcillin-clavulanate is a safe, effective, convenient and practical therapy and is a therapeutic advance over traditional intermittent dosing when used in the home setting. (c) 2005 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.
Keyword Infectious Diseases
Microbiology
Pharmacology & Pharmacy
Beta-lactam
Continuous Infusion
Home Intravenous Therapy
Beta-lactam Antibiotics
Pseudomonas-aeruginosa
Invitro Activity
Cystic-fibrosis
Acid
Intermittent
Combination
Amoxicillin
Inhibitor
Therapy
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: 2006 Higher Education Research Data Collection
School of Medicine Publications
 
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Created: Wed, 15 Aug 2007, 05:37:51 EST