Pharmacokinetics of tigecycline in critically ill patients with liver failure defined by maximal liver function capacity test (LiMAx)
Abstract Background In critically ill patients, tigecycline (TGC) remains an important therapeutic option due to its efficacy against multiresistant Gram-positive and Gram-negative bacteria. TGC is metabolized and eliminated predominantly by the liver. Critical illness-induced liver failure may have...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2020-08-01
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| Series: | Annals of Intensive Care |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13613-020-00707-2 |
| _version_ | 1819168700558737408 |
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| author | Rawan Alraish Sebastian G. Wicha Otto R. Frey Anka C. Roehr Johann Pratschke Martin Stockmann Tilo Wuensch Magnus Kaffarnik |
| author_facet | Rawan Alraish Sebastian G. Wicha Otto R. Frey Anka C. Roehr Johann Pratschke Martin Stockmann Tilo Wuensch Magnus Kaffarnik |
| author_sort | Rawan Alraish |
| collection | DOAJ |
| description | Abstract Background In critically ill patients, tigecycline (TGC) remains an important therapeutic option due to its efficacy against multiresistant Gram-positive and Gram-negative bacteria. TGC is metabolized and eliminated predominantly by the liver. Critical illness-induced liver failure may have a profound impact on the pharmacokinetic of TGC. In the present study, we aimed to establish a link between the degree of liver dysfunction and TGC plasma concentration using the novel maximum liver function capacity (LiMAx) test, as a dynamic liver function test. Materials/methods The prospective study included 33 patients from a surgical ICU with the clinical indication for antibiotic therapy with TGC. The patients received 100 mg loading dose of TGC followed by intermittent standard doses of 50 mg q12. Blood samples for TGC plasma concentration were collected at 0.3, 2, 5, 8 and 11.5 h in a steady-state condition after at least 36 h post-standard dosage. The results were analyzed by means of a high-performance liquid chromatography (HPLC) method. Within the same day, the LiMAx test was carried out and routine blood parameters were measured. Results Peak plasma concentrations of TGC were significantly higher in patients with severe liver failure (LiMAx < 100 µg/kg/h) when compared to patients with normal liver function (LiMAx > 300 µg/kg/h). The pharmacokinetic curves revealed higher values in severe liver failure at any measured point. Moreover, LiMAx and total bilirubin were the only liver-related parameters that correlated with TGC C max. Conclusions The present study demonstrates a high variability of TGC plasma concentrations in critically ill patients. The results show a significant correlation between the degree of liver dysfunction, measured by the LiMAx test, and TGC C max. LiMAx test may be a helpful tool beyond others for adjusting the required dosage of hepatic metabolized antibiotics in critically ill patients. Trial registry DRKS—German clinical trials register; Trial registration number: DRKS00008888; Date of registration: 07-17-2015; Date of enrolment of the first participant to the trial: 12-10-2015 |
| first_indexed | 2024-12-22T19:07:46Z |
| format | Article |
| id | doaj.art-ed651372be7f461492268892b1da5ad3 |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-12-22T19:07:46Z |
| publishDate | 2020-08-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-ed651372be7f461492268892b1da5ad32022-12-21T18:15:45ZengSpringerOpenAnnals of Intensive Care2110-58202020-08-011011910.1186/s13613-020-00707-2Pharmacokinetics of tigecycline in critically ill patients with liver failure defined by maximal liver function capacity test (LiMAx)Rawan Alraish0Sebastian G. Wicha1Otto R. Frey2Anka C. Roehr3Johann Pratschke4Martin Stockmann5Tilo Wuensch6Magnus Kaffarnik7Department of Surgery, Charité - Universitätsmedizin BerlinDept. of Clinical Pharmacy, Institute of Pharmacy, University of HamburgClinical Pharmacy, Klinikum HeidenheimClinical Pharmacy, Klinikum HeidenheimDepartment of Surgery, Charité - Universitätsmedizin BerlinDepartment of Surgery, Charité - Universitätsmedizin BerlinDepartment of Surgery, Charité - Universitätsmedizin BerlinDepartment of Surgery, Charité - Universitätsmedizin BerlinAbstract Background In critically ill patients, tigecycline (TGC) remains an important therapeutic option due to its efficacy against multiresistant Gram-positive and Gram-negative bacteria. TGC is metabolized and eliminated predominantly by the liver. Critical illness-induced liver failure may have a profound impact on the pharmacokinetic of TGC. In the present study, we aimed to establish a link between the degree of liver dysfunction and TGC plasma concentration using the novel maximum liver function capacity (LiMAx) test, as a dynamic liver function test. Materials/methods The prospective study included 33 patients from a surgical ICU with the clinical indication for antibiotic therapy with TGC. The patients received 100 mg loading dose of TGC followed by intermittent standard doses of 50 mg q12. Blood samples for TGC plasma concentration were collected at 0.3, 2, 5, 8 and 11.5 h in a steady-state condition after at least 36 h post-standard dosage. The results were analyzed by means of a high-performance liquid chromatography (HPLC) method. Within the same day, the LiMAx test was carried out and routine blood parameters were measured. Results Peak plasma concentrations of TGC were significantly higher in patients with severe liver failure (LiMAx < 100 µg/kg/h) when compared to patients with normal liver function (LiMAx > 300 µg/kg/h). The pharmacokinetic curves revealed higher values in severe liver failure at any measured point. Moreover, LiMAx and total bilirubin were the only liver-related parameters that correlated with TGC C max. Conclusions The present study demonstrates a high variability of TGC plasma concentrations in critically ill patients. The results show a significant correlation between the degree of liver dysfunction, measured by the LiMAx test, and TGC C max. LiMAx test may be a helpful tool beyond others for adjusting the required dosage of hepatic metabolized antibiotics in critically ill patients. Trial registry DRKS—German clinical trials register; Trial registration number: DRKS00008888; Date of registration: 07-17-2015; Date of enrolment of the first participant to the trial: 12-10-2015http://link.springer.com/article/10.1186/s13613-020-00707-2TigecyclineLiver function testLiMAxPharmacokinetics |
| spellingShingle | Rawan Alraish Sebastian G. Wicha Otto R. Frey Anka C. Roehr Johann Pratschke Martin Stockmann Tilo Wuensch Magnus Kaffarnik Pharmacokinetics of tigecycline in critically ill patients with liver failure defined by maximal liver function capacity test (LiMAx) Annals of Intensive Care Tigecycline Liver function test LiMAx Pharmacokinetics |
| title | Pharmacokinetics of tigecycline in critically ill patients with liver failure defined by maximal liver function capacity test (LiMAx) |
| title_full | Pharmacokinetics of tigecycline in critically ill patients with liver failure defined by maximal liver function capacity test (LiMAx) |
| title_fullStr | Pharmacokinetics of tigecycline in critically ill patients with liver failure defined by maximal liver function capacity test (LiMAx) |
| title_full_unstemmed | Pharmacokinetics of tigecycline in critically ill patients with liver failure defined by maximal liver function capacity test (LiMAx) |
| title_short | Pharmacokinetics of tigecycline in critically ill patients with liver failure defined by maximal liver function capacity test (LiMAx) |
| title_sort | pharmacokinetics of tigecycline in critically ill patients with liver failure defined by maximal liver function capacity test limax |
| topic | Tigecycline Liver function test LiMAx Pharmacokinetics |
| url | http://link.springer.com/article/10.1186/s13613-020-00707-2 |
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