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Co-amoxiclav pharmacokinetics during posttraumatic hemorrhagic shock
O Mimoz1, V Schaeffer, P Incagnoli
1Service d'Anesthésie-Réanimation, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France. o.mimoz@chu-poitiers.fr
Critical Care Medicine
|July 11, 2001
Summary
Severe trauma with hemorrhagic shock alters amoxicillin and clavulanate pharmacokinetics, leading to higher plasma concentrations in patients compared to healthy volunteers. The standard antibiotic dose appears adequate, but tissue concentrations require further investigation.
Area of Science:
- Pharmacology
- Trauma Medicine
- Clinical Pharmacy
Background:
- Severe trauma and hemorrhagic shock significantly impact drug pharmacokinetics.
- Understanding these changes is crucial for optimizing antibiotic dosing in critically ill patients.
Purpose of the Study:
- To investigate the effects of severe trauma and hemorrhagic shock on plasma concentrations and pharmacokinetics of amoxicillin and clavulanate.
- To compare these pharmacokinetic parameters between trauma patients and healthy volunteers.
Main Methods:
- A prospective, open, descriptive study involving 12 trauma patients and 12 matched healthy volunteers.
- Patients received prophylactic amoxicillin (2g) and clavulanate (0.2g) perioperatively.
- Plasma antibiotic concentrations were measured using high-performance liquid chromatography.
Main Results:
- Trauma patients exhibited higher plasma amoxicillin and clavulanate concentrations than volunteers.
- This was primarily due to a reduced volume of distribution and, to a lesser extent, reduced total body clearance in patients.
- Interindividual variability in amoxicillin pharmacokinetics was higher in trauma patients.
Conclusions:
- The standard perioperative dose of amoxicillin and clavulanate appears adequate in trauma patients with hemorrhagic shock based on observed plasma concentrations.
- Further research into tissue antibiotic concentrations is recommended to fully assess therapeutic efficacy.