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

Pleural penetration of amoxicillin and metronidazole during pleural infections: an ambispective cohort study

Résumé

Objectives - The pharmacokinetics of antibiotics in pleural fluid during pleural infections has been poorly described. This study aimed to explore amoxicillin and metronidazole diffusion into the pleural space. Methods - This was an ambispective, single-centre study that included patients with complicated parapneumonic effusion or pleural empyema managed with repeated therapeutic thoracentesis as first-line treatment between 2014 and 2022. Pleural steady-state or trough concentrations of amoxicillin and metronidazole were measured, with a lower limit of quantification of 5 mg/L. Results - Seventy paired blood and pleural samples were analysed from 40 patients. The median (interquartile range) patient age was 55 years (45-67 years) and 88% were male. The median patient weight was 65.8 kg (57.3-82 kg) and median plasma albumin concentration was 29.7 g/L (23.7-33.9 g/L). Median creatinine clearance was 106 mL/min (95-117 mL/min). Median amoxicillin pleural concentrations in patients treated with oral, bolus and continuous intravenous administrations (6 g/day) were, respectively, 5.2 (<5-6.4), 9.4 (8-13.1) and 10.8 (7.1-13.1) mg/L. Pleural concentrations were <5 mg/L in 5/11 samples (45%) with oral treatment and 6/59 (10%) with intravenous treatment. Median metronidazole pleural concentrations were 18.4 (15.7-22.8) mg/L, with all patients being treated orally (1.5 g/day). Conclusions - Oral metronidazole (1.5 g/day) and intravenous amoxicillin (6 g/day) achieved therapeutic targets in pleural fluid in most cases, but oral amoxicillin did not.
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Dates et versions

hal-04282984 , version 1 (11-01-2024)

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David Luque-Paz, Marie-Clémence Verdier, Charles R Lefevre, Pierre Chauvin, Thomas Goter, et al.. Pleural penetration of amoxicillin and metronidazole during pleural infections: an ambispective cohort study. International Journal of Antimicrobial Agents, 2023, 62 (6), pp.107004. ⟨10.1016/j.ijantimicag.2023.107004⟩. ⟨hal-04282984⟩
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