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- Title
Pharmacokinetic study of high-dose oral rifampicin in critically Ill patients with multidrug-resistant Acinetobacter baumannii infection.
- Authors
Karballaei-Mirzahosseini, Hossein; Kaveh-Ahangaran, Romina; Shahrami, Bita; Rouini, Mohammad Reza; Najafi, Atabak; Ahmadi, Arezoo; Sadrai, Sima; Mojtahedzadeh, Amirmahdi; Najmeddin, Farhad; Mojtahedzadeh, Mojtaba
- Abstract
Purpose: Although rifampicin (RIF) is used as a synergistic agent for multidrug-resistant Acinetobacter baumannii (MDR-AB) infection, the optimal pharmacokinetic (PK) indices of this medication have not been studied in the intensive care unit (ICU) settings. This study aimed to evaluate the PK of high dose oral RIF following fasting versus fed conditions in terms of achieving the therapeutic goals in critically ill patients with MDR-AB infections. Methods: 29 critically ill patients were included in this study. Under fasting and non-fasting conditions, RIF was given at 1200 mg once daily through a nasogastric tube. Blood samples were obtained at seven time points: exactly before administration of the drug, and at 1, 2, 4, 8, 12, and 24 h after RIF ingestion. To quantify RIF in serum samples, high-performance liquid chromatography (HPLC) was used. The MONOLIX Software and the Monte Carlo simulations were employed to estimate the PK parameters and describe the population PK model. Results: The mean area under the curve over the last 24-h (AUC0-24) value and accuracy (mean ± standard deviation) in the fasting and fed states were 220.24 ± 119.15 and 290.55 ± 276.20 μg × h/mL, respectively. There was no significant difference among AUCs following fasting and non-fasting conditions (P > 0.05). The probability of reaching the therapeutic goals at the minimum inhibitory concentration (MIC) of 4 mg/L, was only 1.6%. Conclusion: In critically ill patients with MDR-AB infections, neither fasting nor non-fasting administrations of high-dose oral RIF achieve the therapeutic aims. More research is needed in larger populations and with measuring the amount of protein-unbound RIF levels.
- Subjects
FASTING; ACINETOBACTER infections; HIGH performance liquid chromatography; CRITICALLY ill; PATIENTS; RESEARCH funding; DRUG resistance in microorganisms; RIFAMPIN; BLOOD testing; DATA analysis software; STATISTICAL models; PROBABILITY theory
- Publication
DARU: Journal of Pharmaceutical Sciences, 2022, Vol 30, Issue 2, p311
- ISSN
1560-8115
- Publication type
Article
- DOI
10.1007/s40199-022-00449-5