Continuous vs. intermittent cefotaxime administration in patients with chronic obstructive pulmonary disease and respiratory tract infections: pharmacokinetics/pharmacodynamics, bacterial susceptibility and clinical efficacy

A R H van Zanten, M Oudijk, M K E Nohlmans-Paulssen, Y G van der Meer, A R J Girbes, K H Polderman

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

AIM: To compare the pharmacokinetics/pharmacodynamics, antibiotic resistance and clinical efficacy of continuous (CA) vs. intermittent administration (IA) of cefotaxime in patients with obstructive pulmonary disease and respiratory infections.

METHODS: A randomized controlled prospective nonblinded study was performed in 93 consecutive hospitalized patients requiring antibiotics for acute exacerbations of chronic obstructive pulmonary disease. Forty-seven patients received 2 g of cefotaxime intravenously over 24 h plus a loading dose of 1 g, and 46 patients were given the drug intermittently (1 g three times daily).

RESULTS: Similar pathogens were identified in both groups, being mostly Haemophilus influenzae (51%), Streptococcus pneumoniae (21%) and Moraxella catharralis (18%). Mean minimal inhibitory concentration (MIC) values were also similar before and after treatment in both groups. Clinical cure was achieved in 37/40 (93%) (CA) vs. 40/43 (93%) (IA) of patients (P = 0.93). In microbiologically evaluable patients, criteria such as 70% of treatment time with antibiotic concentrations > or = MIC (CA 100%vs. IA 60% of patients) and/or > or = 5 x MIC (CA 100%vs. IA 55% of patients) were significantly better following continuous administration (P < 0.01). Samples with suboptimal antibiotic concentrations were found in 0% of CA vs. 65% of IA patients (P < 0.01).

CONCLUSIONS: Although clinical cure rates were comparable, continuous cefotaxime administration led to significantly greater proportions of concentrations > MIC and > 5 x MIC compared with intermittent dosing. Continuous administration of cefotaxime at a lower dose [2 g (CA) vs. 3 g (CI)] is equally effective pharmacodynamically and microbiologically, may be more cost-effective and offers at least the same clinical efficacy. Based on these observations, we recommend continuous administration of cefotaxime as the preferred mode of administration.

Original languageEnglish
Pages (from-to)100-9
Number of pages10
JournalBritish Journal of Clinical Pharmacology
Volume63
Issue number1
DOIs
Publication statusPublished - Jan 2007

Cite this

@article{676ef936c4204dd8ae64e8d8dd83e8a0,
title = "Continuous vs. intermittent cefotaxime administration in patients with chronic obstructive pulmonary disease and respiratory tract infections: pharmacokinetics/pharmacodynamics, bacterial susceptibility and clinical efficacy",
abstract = "AIM: To compare the pharmacokinetics/pharmacodynamics, antibiotic resistance and clinical efficacy of continuous (CA) vs. intermittent administration (IA) of cefotaxime in patients with obstructive pulmonary disease and respiratory infections.METHODS: A randomized controlled prospective nonblinded study was performed in 93 consecutive hospitalized patients requiring antibiotics for acute exacerbations of chronic obstructive pulmonary disease. Forty-seven patients received 2 g of cefotaxime intravenously over 24 h plus a loading dose of 1 g, and 46 patients were given the drug intermittently (1 g three times daily).RESULTS: Similar pathogens were identified in both groups, being mostly Haemophilus influenzae (51{\%}), Streptococcus pneumoniae (21{\%}) and Moraxella catharralis (18{\%}). Mean minimal inhibitory concentration (MIC) values were also similar before and after treatment in both groups. Clinical cure was achieved in 37/40 (93{\%}) (CA) vs. 40/43 (93{\%}) (IA) of patients (P = 0.93). In microbiologically evaluable patients, criteria such as 70{\%} of treatment time with antibiotic concentrations > or = MIC (CA 100{\%}vs. IA 60{\%} of patients) and/or > or = 5 x MIC (CA 100{\%}vs. IA 55{\%} of patients) were significantly better following continuous administration (P < 0.01). Samples with suboptimal antibiotic concentrations were found in 0{\%} of CA vs. 65{\%} of IA patients (P < 0.01).CONCLUSIONS: Although clinical cure rates were comparable, continuous cefotaxime administration led to significantly greater proportions of concentrations > MIC and > 5 x MIC compared with intermittent dosing. Continuous administration of cefotaxime at a lower dose [2 g (CA) vs. 3 g (CI)] is equally effective pharmacodynamically and microbiologically, may be more cost-effective and offers at least the same clinical efficacy. Based on these observations, we recommend continuous administration of cefotaxime as the preferred mode of administration.",
keywords = "Adult, Aged, Anti-Bacterial Agents/administration & dosage, Cefotaxime/administration & dosage, Disease Susceptibility/etiology, Female, Humans, Male, Middle Aged, Prospective Studies, Pulmonary Disease, Chronic Obstructive/drug therapy, Respiratory Tract Infections/drug therapy",
author = "{van Zanten}, {A R H} and M Oudijk and Nohlmans-Paulssen, {M K E} and {van der Meer}, {Y G} and Girbes, {A R J} and Polderman, {K H}",
year = "2007",
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pages = "100--9",
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issn = "0306-5251",
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Continuous vs. intermittent cefotaxime administration in patients with chronic obstructive pulmonary disease and respiratory tract infections : pharmacokinetics/pharmacodynamics, bacterial susceptibility and clinical efficacy. / van Zanten, A R H; Oudijk, M; Nohlmans-Paulssen, M K E; van der Meer, Y G; Girbes, A R J; Polderman, K H.

In: British Journal of Clinical Pharmacology, Vol. 63, No. 1, 01.2007, p. 100-9.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Continuous vs. intermittent cefotaxime administration in patients with chronic obstructive pulmonary disease and respiratory tract infections

T2 - pharmacokinetics/pharmacodynamics, bacterial susceptibility and clinical efficacy

AU - van Zanten, A R H

AU - Oudijk, M

AU - Nohlmans-Paulssen, M K E

AU - van der Meer, Y G

AU - Girbes, A R J

AU - Polderman, K H

PY - 2007/1

Y1 - 2007/1

N2 - AIM: To compare the pharmacokinetics/pharmacodynamics, antibiotic resistance and clinical efficacy of continuous (CA) vs. intermittent administration (IA) of cefotaxime in patients with obstructive pulmonary disease and respiratory infections.METHODS: A randomized controlled prospective nonblinded study was performed in 93 consecutive hospitalized patients requiring antibiotics for acute exacerbations of chronic obstructive pulmonary disease. Forty-seven patients received 2 g of cefotaxime intravenously over 24 h plus a loading dose of 1 g, and 46 patients were given the drug intermittently (1 g three times daily).RESULTS: Similar pathogens were identified in both groups, being mostly Haemophilus influenzae (51%), Streptococcus pneumoniae (21%) and Moraxella catharralis (18%). Mean minimal inhibitory concentration (MIC) values were also similar before and after treatment in both groups. Clinical cure was achieved in 37/40 (93%) (CA) vs. 40/43 (93%) (IA) of patients (P = 0.93). In microbiologically evaluable patients, criteria such as 70% of treatment time with antibiotic concentrations > or = MIC (CA 100%vs. IA 60% of patients) and/or > or = 5 x MIC (CA 100%vs. IA 55% of patients) were significantly better following continuous administration (P < 0.01). Samples with suboptimal antibiotic concentrations were found in 0% of CA vs. 65% of IA patients (P < 0.01).CONCLUSIONS: Although clinical cure rates were comparable, continuous cefotaxime administration led to significantly greater proportions of concentrations > MIC and > 5 x MIC compared with intermittent dosing. Continuous administration of cefotaxime at a lower dose [2 g (CA) vs. 3 g (CI)] is equally effective pharmacodynamically and microbiologically, may be more cost-effective and offers at least the same clinical efficacy. Based on these observations, we recommend continuous administration of cefotaxime as the preferred mode of administration.

AB - AIM: To compare the pharmacokinetics/pharmacodynamics, antibiotic resistance and clinical efficacy of continuous (CA) vs. intermittent administration (IA) of cefotaxime in patients with obstructive pulmonary disease and respiratory infections.METHODS: A randomized controlled prospective nonblinded study was performed in 93 consecutive hospitalized patients requiring antibiotics for acute exacerbations of chronic obstructive pulmonary disease. Forty-seven patients received 2 g of cefotaxime intravenously over 24 h plus a loading dose of 1 g, and 46 patients were given the drug intermittently (1 g three times daily).RESULTS: Similar pathogens were identified in both groups, being mostly Haemophilus influenzae (51%), Streptococcus pneumoniae (21%) and Moraxella catharralis (18%). Mean minimal inhibitory concentration (MIC) values were also similar before and after treatment in both groups. Clinical cure was achieved in 37/40 (93%) (CA) vs. 40/43 (93%) (IA) of patients (P = 0.93). In microbiologically evaluable patients, criteria such as 70% of treatment time with antibiotic concentrations > or = MIC (CA 100%vs. IA 60% of patients) and/or > or = 5 x MIC (CA 100%vs. IA 55% of patients) were significantly better following continuous administration (P < 0.01). Samples with suboptimal antibiotic concentrations were found in 0% of CA vs. 65% of IA patients (P < 0.01).CONCLUSIONS: Although clinical cure rates were comparable, continuous cefotaxime administration led to significantly greater proportions of concentrations > MIC and > 5 x MIC compared with intermittent dosing. Continuous administration of cefotaxime at a lower dose [2 g (CA) vs. 3 g (CI)] is equally effective pharmacodynamically and microbiologically, may be more cost-effective and offers at least the same clinical efficacy. Based on these observations, we recommend continuous administration of cefotaxime as the preferred mode of administration.

KW - Adult

KW - Aged

KW - Anti-Bacterial Agents/administration & dosage

KW - Cefotaxime/administration & dosage

KW - Disease Susceptibility/etiology

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Prospective Studies

KW - Pulmonary Disease, Chronic Obstructive/drug therapy

KW - Respiratory Tract Infections/drug therapy

U2 - 10.1111/j.1365-2125.2006.02730.x

DO - 10.1111/j.1365-2125.2006.02730.x

M3 - Article

VL - 63

SP - 100

EP - 109

JO - British Journal of Clinical Pharmacology

JF - British Journal of Clinical Pharmacology

SN - 0306-5251

IS - 1

ER -