| Pharmacokinetics of Teicoplanin
in Patients Undergoing Open Heart Surgery |
(Department of Surgery and Department of Anesthesiology*,
The Cardiovascular Institute Hospital, Tokyo, Japan)
| Toshihisa Asakura |
Keiichi Aoki |
Yoshiharu Enomoto |
| Yoshihito Inai |
Shoichi Furuta |
Tamami Takahashi* |
| Eiichi Inada* |
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The purpose of this study was to
investigate the pharmacokinetics of teicoplanin (TEIC) in patients
undergoing open heart surgery. We also attemped to define the
optimum TEIC therapy protocol for prevention of perioperative
infection and for treatment of staphylococcal endocarditis such
as that caused by methicillin-resistant Staphylococcus aureus
(MRSA). Serum TEIC concentrations were measured in 14 patients
divided into two groups of 7 patients each undergoing elective
open heart surgery. Patients in group I received 400mg of TEIC
and patients in group II received 800mg, both administered as
a slow intravenous infusion over 20min immediately after induction
of anesthesia. The peak serum level (mean}standard error) of
TEIC was respectively 57}11 and 139}39Κg/ml at 2min after administration
and then the TEIC level decreased gradually to 26}7 and 55}10Κg/ml
at 60min after administration. The serum level of TEIC decreased
rapidly to 17}5 and 31}7Κg/ml, respectively, at the start of
extracorporeal circulation (ECC), and was 11}2 and 27}6Κg/ml
after 60min of ECC, 8}2 and 23}7Κg/ml at 2min after the termination
of ECC, 8}3 and 23}6Κg/ml at 60min after the termination of ECC,
and 7}2 and 22}5Κg/ml on admission to ICU. No side effects were
seen during the study, such as red neck syndrome, renal dysfunction,
hearing disorders, or postoperative infection. Our results suggested
that the optimum dose of TEIC for prevention of perioperative
infection was around 400mg, providing levels in excess of the
MIC for most pathogens that have been found to cause infection
following open heart surgery, including MRSA. In addition, a
dose of 800mg was needed to keep trough levels above 20Κg/ml
for treatment of staphylococcal endocarditis. It was also suggested
that half of the initial dose should be administered on admission
to ICU and also at the start of ECC if the operation is going
to last longer than 7h on the basis of the concentration-time
curve.
@Jpn. J. Cardiovasc. Surg. 30: 226-229 (2001) |
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