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Article Dans Une Revue International Journal of Antimicrobial Agents Année : 2023

Amoxicillin therapeutic drug monitoring for endocarditis: a comparative study (EI-STAB)

Résumé

Introduction - International guidelines recommend high doses of β-lactams for most cases of infective endocarditis (IE). Therapeutic drug monitoring (TDM) is increasingly used to adjust β-lactam dose based on plasma concentrations, although there are no comparative studies to support this practice. The benefit of amoxicillin TDM during IE was evaluated. Methods - An observational, retrospective, cohort study of adults treated with high-dose amoxicillin for enterococcal or streptococcal IE was conducted in two referral centers. Patients with, or without TDM were compared. The primary outcome was mean daily amoxicillin dose. Results - A total of 206 cases of streptococcal (n=140, 68%) or enterococcal (n=66, 32%) IE were included. IE occurred on prosthetic valves in 77 (37%) cases, and on intracardiac devices in 28 (14%) cases. Aortic valve was involved in 136 (66%) cases. There were 154 men (75%), mean age was 70 ± 14 years, valve surgery was performed in 81/206 (39%) patients, and in-hospital mortality was 8% (17/206). All patients in the TDM group and most patients in the group without TDM received amoxicillin as continuous infusion. Amoxicillin TDM was performed for 114 patients (55.3%), with a mean of 4.7 ± 2.3 measures per patient, a mean plasma steady-state concentration of 41.2 ± 19 mg/L, most (82/114, 72%) being within the therapeutic target (20-80 mg/L). Mean amoxicillin dose was lower in patients with TDM (10.0 ± 3.3 g/day) than those without TDM (11.3 ± 2.0 g/day) (P=0.003). Conclusion - Amoxicillin TDM was associated with a reduction in daily doses, with no impact on adverse events and prognosis. Individualized treatment of IE through TDM may contribute to decreased use of antibiotics.
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Dates et versions

hal-04088815 , version 1 (16-05-2023)

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Paternité - Pas d'utilisation commerciale

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Marie Dorel, Robin Albert, Audrey Le Bot, Leïla Caillault, Sébastien Lalanne, et al.. Amoxicillin therapeutic drug monitoring for endocarditis: a comparative study (EI-STAB). International Journal of Antimicrobial Agents, 2023, 62 (1), pp.106821. ⟨10.1016/j.ijantimicag.2023.106821⟩. ⟨hal-04088815⟩
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