European Journal of Biomedical and Pharmaceutical Sciences

THE PHARMACODYNAMIC/PHARMACOKINETIC EVALUATION STUDY OF SERUM LEVELS OF CEFOTAXIME IN CRITICALLY ILL PATIENTS: A PILOT STUDY

Devendra Kumar Katiyar and Ravishankar Srivastav*

ABSTRACT

Introduction: Cefotaxime (CTX) is a broad-spectrum β-lactam antibiotic in the third-generation class of cephalosporins, with active against numerous Gram-positive and Gram-negative bacteria. The critically ill patient population being the most obvious choice for our study are usually prone to Nosocomial infections which are frequently acquired in the intensive care unit. This state is worrisome, if not handled and managed adequately with required dosage regime of the antibiotics. Aim: The purpose of this study was to evaluate the variability in the concentration of cefotaxime in critically ill (ICU) patients at different time intervals by grouping patients according to their site of infection and determining the number of patients in which the concentration of cefotaxime was below the minimum inhibitory concentration (MIC) and below 5 times the MIC for the isolated organism. Material and methods: It is a pilot analytical study with a sample size of 25 patients admitted to the ICU and receiving cefotaxime antibiotic, age group ranging from 20-75 yrs of age. The patients were grouped according to their Locus of infection as hepatobiliary and renal. Approximately, 2 ml of blood was withdrawn from the patients through the intravenous route at time points of 1, 2, 4, and 8 h postinfusion. Cefotaxime concentration in plasma was estimated using high-performance liquid chromatography. Then Antimicrobial susceptibility tests were performed by the disk diffusion method. Results: It was seen that the weight versus plasma concentration of cefotaxime at 1, 2, 4, and 8 h intervals did not show any significant correlation. The microorganisms were isolated and was observed that the plasma concentration of cefotaxime when compared with the hepatobiliary and the nonhepatobiliary groups, was not significant at 1h after cefotaxime dosing (P >0.05) while that between the renal and the nonrenal groups was statistically significant at all the time points {1 h (P =<0.005), 4 h (P <0.001), and 8 h (P <0.05)}. Cefotaxime concentration exceeded the MIC for most of the pathogens and Almost all patients had cefotaxime levels above 5 times the MIC for the causative organism studied except few microorganisms. Conclusion: Constant evaluation of current practice of consumption of antibiotics on basis of trends and antibiotic patterns is essential to make progress in this problematic matter. additional studies are needed on indian populatipn in future so we can slow down the emergence of antimicrobial resistance in such extremely vulnerable population of critically ill patient population.

Keywords: Cefotaxime (CTX), hepatobiliary.