Pharmacokinetics of Small Spectrum Beta-lactam Antibiotics (Amoxicillin/Clavulanic Acid and Cefuroxime) in Patients on Intensive Care Units

Study Overview
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Brief Summary
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Adequate antibiotic therapy is very important in the treatment of infections. Spectrum and dosing of the antibiotics are two factors of the therapy: the spectrum of an antibiotic can't be changed, but the dosing scheme can be optimized. Recent studies proved that an optimized dosing scheme can improve the efficacy of the treatment. Broad-spectrum antibiotics have unpredictable pharmacokinetics in patients on intensive care units. This is due to the pathophysiologic processes in the patients on intensive care units: increased distribution volume, hypoproteinemia, organ failure… The investigators guess that similar processes influence the pharmacokinetics of small spectrum antibiotics (like amoxicillin and cefuroxime), but data lacks. Because the pharmacokinetics of broad spectrum antibiotics in seriously ill patients are better known, physicians are more confident prescribing these drugs. Studying the pharmacokinetic interactions of small spectrum antibiotics in seriously ill patients, can help to give the physician the confidence to prescribe these small-spectrum antibiotics. In this study, the investigators will study the pharmacokinetics of amoxicillin/clavulanic acid and cefuroxime, in 60 patients on intensive care. 8 blood samples will be drawn via a central catheter on different moments after one administration of the antibiotic in the steady state phase. All the patients are prescribed the antibiotics for the treatment of their infections: they get the antibiotic therapy anyway. By measuring the concentrations on different moments after one administration, the investigators can reconstruct the pharmacokinetic function.

Official Title
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Pharmacokinetics of Small Spectrum Beta-lactam Antibiotics (Amoxicillin/Clavulanic Acid and Cefuroxime) in Patients on Intensive Care Units

Conditions
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Infection

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients on the intensive care unit, who are treated with amoxicillin/clavulanic acid or cefuroxime for an infection Exclusion Criteria: informed consent lacking haematocrit < 21 % arterial catheter lacking

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Amoxicillin/Clavulanic Acid<br>Patients in the intensive care unit, with an infection which will be treated with Amoxicillin/Clavulanic Acid. | |
| Cefuroxime<br>Patients in the intensive care unit, with an infection which will be treated with Cefuroxime. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Area under the serum concentration versus time curve (AUC) of Amoxicillin/Clavulanic acid. | The concentrations of the antibiotic in serum samples, drawn at various times after one administration, will be measured. With these data, we can calculate the time above the minimal inhibitory concentration (MIC). | Before and at 15, 30, 45, 60, 120, 240 and 360 minutes after administration | 
| Area under the serum concentration versus time curve (AUC) of Cefuroxime. | The concentrations of the antibiotic in serum samples, drawn at various times after one administration, will be measured. With these data, we can calculate the time above the minimal inhibitory concentration (MIC). | Before and at 15, 30, 45, 60, 120, 240 and 480 minutes after administration | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Severity of disease classification. | This will be assessed using the Acute Physiology and Chronic Health Evaluation II (APACHE2)-score. | At date of admission (day 1) and dismissal (up to 3 months). | 
| Rate of organ failure. | This will be assessed using the Sequential Organ Failure Assessment score (SOFA-score). | At date of admission (day 1) and dismissal (up to 3 months). | 
| Concentration serum creatinin |  | At day 1. | 
| 24 hour urine creatinine clearance | Urine will be collected during 24 hours to measure the urine creatinine clearance. | At 24 hours | 
| Change in fluid balance | Change in fluid balance will be measured. | From 0 to 24 hours. | 
| Concentration serum albumin |  | At day 1. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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amoxicillin, clavulanic acid, cefuroxime, Patients in the intensive care unit, with an infection which requires amoxicillin/clavulanic acid or cefuroxime