Pharmacokinetic variability of clindamycin and influence of rifampicin on clindamycin concentration in patients with bone and joint infections View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2015-04-03

AUTHORS

Emmanuel Curis, Vincent Pestre, Vincent Jullien, Luc Eyrolle, Denis Archambeau, Philippe Morand, Laure Gatin, Matthieu Karoubi, Nicolas Pinar, Valérie Dumaine, Jean-Claude Nguyen Van, Antoine Babinet, Philippe Anract, Dominique Salmon

ABSTRACT

PurposeClindamycin, a lincosamide antibiotic with a good penetration into bone, is widely used for treating bone and joint infections by Gram-positive pathogens. To be active against Staphylococcus spp, its concentration at the infection site, C, must be higher than 2× the minimal inhibitory concentration (MIC). The aims of the work were to study the determinants of plasma clindamycin trough concentration, Cmin, especially the effect of co-treatment with rifampicin, and the consequences on clinical outcome.MethodsAn observational study was performed, involving patients hospitalized for a bone and joint infection who received clindamycin as part of their antibiotic treatment. Target Cmin was 1.7 mg/L, to reach the desired bone concentration/MIC >2, assuming a 30 % diffusion into bone and MIC = 2.5 mg/L.ResultsSixty one patients (mean age: 56.8 years, 57.4 % male) were included between 2007 and 2011. 72.1 % underwent a surgery on a foreign material, and 91.1 % were infected by at least a Gram-positive micro-organism. Median Cmin value was 1.39 mg/L, with 58 % of the values below the threshold value of 1.7 mg/L. Median Cmin was significantly lower for patients taking rifampicin (0.46 vs 1.52 mg/L, p = 0.034). No patient with rifampicin co-administration reached the target concentration (maximal Cmin: 0.85 mg/L). After a median follow-up of 17 months (1.5–38 months), 4 patients relapsed, 2 died and 47 (88.7 % of the patients with known outcome) were cured, independently of association with rifampicin.ConclusionsThis study shows the high inter-variability of plasma clindamycin concentration and confirms that co-treatment with rifampicin significantly decreases clindamycin trough concentrations. More... »

PAGES

473-481

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s15010-015-0773-y

DOI

http://dx.doi.org/10.1007/s15010-015-0773-y

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1005432321

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/25837442


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24 schema:description PurposeClindamycin, a lincosamide antibiotic with a good penetration into bone, is widely used for treating bone and joint infections by Gram-positive pathogens. To be active against Staphylococcus spp, its concentration at the infection site, C, must be higher than 2× the minimal inhibitory concentration (MIC). The aims of the work were to study the determinants of plasma clindamycin trough concentration, Cmin, especially the effect of co-treatment with rifampicin, and the consequences on clinical outcome.MethodsAn observational study was performed, involving patients hospitalized for a bone and joint infection who received clindamycin as part of their antibiotic treatment. Target Cmin was 1.7 mg/L, to reach the desired bone concentration/MIC >2, assuming a 30 % diffusion into bone and MIC = 2.5 mg/L.ResultsSixty one patients (mean age: 56.8 years, 57.4 % male) were included between 2007 and 2011. 72.1 % underwent a surgery on a foreign material, and 91.1 % were infected by at least a Gram-positive micro-organism. Median Cmin value was 1.39 mg/L, with 58 % of the values below the threshold value of 1.7 mg/L. Median Cmin was significantly lower for patients taking rifampicin (0.46 vs 1.52 mg/L, p = 0.034). No patient with rifampicin co-administration reached the target concentration (maximal Cmin: 0.85 mg/L). After a median follow-up of 17 months (1.5–38 months), 4 patients relapsed, 2 died and 47 (88.7 % of the patients with known outcome) were cured, independently of association with rifampicin.ConclusionsThis study shows the high inter-variability of plasma clindamycin concentration and confirms that co-treatment with rifampicin significantly decreases clindamycin trough concentrations.
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31 schema:keywords Cmin
32 Cmin values
33 ConclusionsThis study
34 Gram
35 Gram-positive pathogens
36 Median Cmin value
37 MethodsAn observational study
38 PurposeClindamycin
39 ResultsSixty one patients
40 Staphylococcus spp
41 aim
42 antibiotic treatment
43 association
44 bone
45 bone concentration/MIC
46 clindamycin
47 clindamycin concentrations
48 clindamycin trough concentration
49 clinical outcomes
50 co-administration
51 concentration
52 concentration/MIC
53 consequences
54 determinants
55 diffusion
56 effect
57 foreign material
58 good penetration
59 infection
60 infection site
61 influence
62 influence of rifampicin
63 inhibitory concentration
64 joint infection
65 lincosamides
66 materials
67 median Cmin
68 minimal inhibitory concentration
69 months
70 observational study
71 one patient
72 outcomes
73 part
74 pathogens
75 patients
76 penetration
77 pharmacokinetic variability
78 plasma clindamycin concentration
79 plasma clindamycin trough concentration
80 rifampicin
81 rifampicin co-administration
82 sites
83 spp
84 study
85 surgery
86 target Cmin
87 target concentration
88 threshold value
89 treatment
90 trough concentrations
91 values
92 variability
93 work
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