BACKGROUND: Critically ill patients often demonstrate extremely unusual volumes of distribution (Vd) and half-lives (t1/2) of drugs. Imipenem is a widely used antibiotic in critically ill patients. METHODS: We performed high-performance liquid chromatography analysis of imipenem in samples from 50 critically ill patients treated with either 500 or 1,000 mg. RESULTS: Peak imipenem levels varied from 1.56 microg/mL to 58.8 microg/mL. Trough levels varied between 0.0 microg/mL and 15.62 microg/mL. Only 54% of patients maintained a trough level greater than 4 microg/mL. Both the Vd and the t1/2 of imipenem were much greater than observed in other patient populations. CONCLUSION: The pharmacokinetic activity of imipenem in critically ill patients is different from that in other patient populations. There is a very weak correlation between dosage and serum concentrations. Therapeutic failures of imipenem may be because of unpredictable pharmacodynamics (Vd and t1/2) in critically ill surgical patients.
BACKGROUND:Critically illpatients often demonstrate extremely unusual volumes of distribution (Vd) and half-lives (t1/2) of drugs. Imipenem is a widely used antibiotic in critically illpatients. METHODS: We performed high-performance liquid chromatography analysis of imipenem in samples from 50 critically illpatients treated with either 500 or 1,000 mg. RESULTS: Peak imipenem levels varied from 1.56 microg/mL to 58.8 microg/mL. Trough levels varied between 0.0 microg/mL and 15.62 microg/mL. Only 54% of patients maintained a trough level greater than 4 microg/mL. Both the Vd and the t1/2 of imipenem were much greater than observed in other patient populations. CONCLUSION: The pharmacokinetic activity of imipenem in critically illpatients is different from that in other patient populations. There is a very weak correlation between dosage and serum concentrations. Therapeutic failures of imipenem may be because of unpredictable pharmacodynamics (Vd and t1/2) in critically ill surgical patients.
Authors: Eric Giannoni; Philippe Moreillon; Jacques Cotting; Adrien Moessinger; Jacques Bille; Laurent Décosterd; Giorgio Zanetti; Paul Majcherczyk; Denis Bugnon Journal: Antimicrob Agents Chemother Date: 2006-07 Impact factor: 5.191
Authors: Thomas M Chapuis; Eric Giannoni; Paul A Majcherczyk; René Chioléro; Marie-Denise Schaller; Mette M Berger; Saskia Bolay; Laurent A Décosterd; Denis Bugnon; Philippe Moreillon Journal: Crit Care Date: 2010-04-01 Impact factor: 9.097
Authors: David S Gomez; Cristina Sanches-Giraud; Carlindo V Silva; Amanda M Ribas Rosa Oliveira; Joao Manoel da Silva; Rolf Gemperli; Silvia R C J Santos Journal: J Antibiot (Tokyo) Date: 2014-09-17 Impact factor: 2.649