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Abstract
Background and goal
β-lactams are time-dependent antibiotics and show little gain in activity once their
concentration exceeds the minimum inhibitory concentration about fourfold, which suggests
their administration by continuous infusion. We have studied the stability, the compatibility
with other drugs, and the pharmacokinetics of continuous or intermittent administration
of temocillin (a β-lactam active against Gram-negative organisms).
Methods
Temocillin was assayed by HPLC. Temocillin stability was measured over 24 hours after
its solution in water at 37°C. Compatibility with several frequently used drugs on
the ICU was determined under conditions mimicking their clinical use. Temocillin was
measured in plasma samples from ICU patients with normal renal function, randomly
assigned to receive a continuous (n = 6; 2 g every 12 hours; 5 day sample observation)
or intermittent (n = 6; 2 g over 30 minutes twice daily; consecutive samples before
and after dose 1 and 9) schedule.
Results
Recovery after storage for 24 hours at 37°C of both R and S isomers of temocillin
exceeded 90%, which is better among other studied β-lactams. Temocillin was compatible
with most frequently used drugs on the ICU with the exception of clarithromycin, ciprofloxacin,
meropenem, imipenem, piperacillin/tazobactam, vancomycin, amoxicillin/acid clavulanic
acid, propofol, midazolam, piritramide, nicardipine, milrinone, and ranitidine. In
patients with normal renal function, plasma levels of temocillin were above 50 mg/l
in the continuous group, and 90% of the time above the breakpoint of 16 mg/l with
peak levels of 120 mg/l after the first and ninth dose in the intermittent group.
Conclusion
Temocillin can be used safely in the ICU, either with an intermittent or continuous
schedule. The latter may be preferred based on pharmacodynamic considerations.