Retrospective analysis of a flucloxacillin oral absorption test in patients requiring flucloxacillin therapy: results and determination of factors associated with adequate absorption.

IF 1.6 4区 医学 Q2 Medicine Acta Clinica Belgica Pub Date : 2024-06-01 Epub Date: 2024-07-26 DOI:10.1080/17843286.2024.2382981
Sanne De Smet, Pieter De Cock, Nick Verougstraete, Franky Buyle, Jerina Boelens, Diana Huis In 't Veld
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Abstract

Objectives: Flucloxacillin has the most narrow spectrum to treat staphylococcal infections, but has a large variability in bioavailability which hampers its intravenous (iv) to oral switch. To identify patients with adequate absorption, the use of an oral absorption test (OAT) measuring total plasma concentrations of flucloxacillin before and after an oral dose of 1 gram flucloxacillin, was previously published. The current pilot study aims to evaluate the fraction of patients with adequate absorption using a similar OAT; to assess the therapeutic consequences and to identify potential factors associated with adequate absorption.

Methods: Demographic data of adult patients treated with iv flucloxacillin and requiring prolonged therapy were collected retrospectively between May 2020 and November 2021 at Ghent University Hospital. A previously published OAT protocol was used, with addition of a protocol for intermittent dosing of iv flucloxacillin. Adequate absorption was defined as an increase in plasma concentration of at least 10 mg/L.

Results: The flucloxacillin OAT was performed in 99 patients, of which 62% were men, with a median age of 58 years and 95% received intermittent dosing of iv flucloxacillin. Of the 99 patients, 55% had a result indicating an adequate absorption and 49% of all patients were switched to oral flucloxacillin afterwards. Inadequate absorption was found to be associated with higher Body Mass Index and higher flucloxacillin baseline concentration, while co-administration of acetylsalicylic acid was associated with an adequate absorption.

Conclusions: Based on the OAT, 49% of all patients were switched to oral flucloxacillin instead of broader-spectrum anti-staphylococcal antibiotics. This implicates that an OAT could be a valuable antimicrobial stewardship measure by restricting the use of broad-spectrum antibiotics. For each of the associations found, a hypothesis was formulated about the underlying reason or mechanism; these should be confirmed in future studies with prospective and multicentric design.

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对需要接受氟氯西林治疗的患者进行氟氯西林口服吸收试验的回顾性分析:结果及确定与充分吸收有关的因素。
目的:氟氯西林是治疗葡萄球菌感染的最窄谱药物,但其生物利用度变化很大,阻碍了从静脉注射到口服的转换。为了确定患者是否有足够的吸收能力,以前曾发表过一项口服吸收试验(OAT),测量口服 1 克氟氯西林前后氟氯西林的总血浆浓度。本试验研究旨在使用类似的口服吸收试验评估充分吸收患者的比例;评估治疗效果并确定与充分吸收相关的潜在因素:方法:在 2020 年 5 月至 2021 年 11 月期间,在根特大学医院回顾性收集了接受氟氯西林静脉注射治疗并需要长期治疗的成年患者的人口统计学数据。研究采用了之前公布的 OAT 方案,并增加了间歇性静脉注射氟氯西林的方案。充分吸收的定义是血浆浓度至少增加 10 毫克/升:99名患者接受了氟氯西林OAT治疗,其中62%为男性,中位年龄为58岁,95%接受了间歇性静脉注射氟氯西林。在 99 名患者中,55% 的结果显示吸收充分,49% 的患者随后转为口服氟氯西林。研究发现,吸收不足与较高的体重指数和较高的氟氯西林基线浓度有关,而同时服用乙酰水杨酸则与吸收充足有关:根据 OAT,49% 的患者改用口服氟氯西林,而不是更广谱的抗葡萄球菌抗生素。这表明,OAT 可以限制广谱抗生素的使用,从而成为一项有价值的抗菌药物管理措施。对于发现的每种关联,我们都提出了潜在原因或机制的假设;这些假设应在未来的前瞻性多中心设计研究中得到证实。
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来源期刊
Acta Clinica Belgica
Acta Clinica Belgica 医学-医学:内科
CiteScore
2.90
自引率
0.00%
发文量
44
审稿时长
6-12 weeks
期刊介绍: Acta Clinica Belgica: International Journal of Clinical and Laboratory Medicine primarily publishes papers on clinical medicine, clinical chemistry, pathology and molecular biology, provided they describe results which contribute to our understanding of clinical problems or describe new methods applicable to clinical investigation. Readership includes physicians, pathologists, pharmacists and physicians working in non-academic and academic hospitals, practicing internal medicine and its subspecialties.
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