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Erschienen in: Infection 4/2015

01.08.2015 | Original Paper

Pharmacokinetic variability of clindamycin and influence of rifampicin on clindamycin concentration in patients with bone and joint infections

verfasst von: Emmanuel Curis, Vincent Pestre, Vincent Jullien, Luc Eyrolle, Denis Archambeau, Philippe Morand, Laure Gatin, Matthieu Karoubi, Nicolas Pinar, Valérie Dumaine, Jean-Claude Nguyen Van, Antoine Babinet, Philippe Anract, Dominique Salmon

Erschienen in: Infection | Ausgabe 4/2015

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Abstract

Purpose

Clindamycin, a lincosamide antibiotic with a good penetration into bone, is widely used for treating bone and joint infections by Gram-positive pathogens. To be active against Staphylococcus spp, its concentration at the infection site, C, must be higher than 2× the minimal inhibitory concentration (MIC). The aims of the work were to study the determinants of plasma clindamycin trough concentration, C min, especially the effect of co-treatment with rifampicin, and the consequences on clinical outcome.

Methods

An observational study was performed, involving patients hospitalized for a bone and joint infection who received clindamycin as part of their antibiotic treatment. Target C min was 1.7 mg/L, to reach the desired bone concentration/MIC >2, assuming a 30 % diffusion into bone and MIC = 2.5 mg/L.

Results

Sixty one patients (mean age: 56.8 years, 57.4 % male) were included between 2007 and 2011. 72.1 % underwent a surgery on a foreign material, and 91.1 % were infected by at least a Gram-positive micro-organism. Median C min value was 1.39 mg/L, with 58 % of the values below the threshold value of 1.7 mg/L. Median C min was significantly lower for patients taking rifampicin (0.46 vs 1.52 mg/L, p = 0.034). No patient with rifampicin co-administration reached the target concentration (maximal C min: 0.85 mg/L). After a median follow-up of 17 months (1.5–38 months), 4 patients relapsed, 2 died and 47 (88.7 % of the patients with known outcome) were cured, independently of association with rifampicin.

Conclusions

This study shows the high inter-variability of plasma clindamycin concentration and confirms that co-treatment with rifampicin significantly decreases clindamycin trough concentrations.
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Metadaten
Titel
Pharmacokinetic variability of clindamycin and influence of rifampicin on clindamycin concentration in patients with bone and joint infections
verfasst von
Emmanuel Curis
Vincent Pestre
Vincent Jullien
Luc Eyrolle
Denis Archambeau
Philippe Morand
Laure Gatin
Matthieu Karoubi
Nicolas Pinar
Valérie Dumaine
Jean-Claude Nguyen Van
Antoine Babinet
Philippe Anract
Dominique Salmon
Publikationsdatum
01.08.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Infection / Ausgabe 4/2015
Print ISSN: 0300-8126
Elektronische ISSN: 1439-0973
DOI
https://doi.org/10.1007/s15010-015-0773-y

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