Assessment of the suitability of empirical levofloxacin according to the auc/mic parameter in hospitalized patients

• Autores: Carlos Devesa García, Francisco José Rodríguez Lucena, Gabriel Martínez Orea, Ana Candela Fajardo, N. Cano Cuenca, Rodrigo Bonilla Peñarrubia, Pablo Pérez Huertas, Elena Arroyo Domingo
• Localización: European journal of clinical pharmacy: atención farmacéutica, ISSN 2385-409X, Vol. 24, Nº. 1, 2022, págs. 3-3
• Idioma: inglés
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• Resumen

  • Objective: Retrospective, cross-sectional, observational study that aims to answer the question whether the prescribed doses of levofloxacin are suitable based on current target exposure recommendations (AUC/MIC) and pathophysiological and anthropometric characteristics for correct use, maximizing effectiveness, and minimizing possible potential appearance of resistance to treatment.

    Method: The minimum objective value of AUC is set at 180, a value with which effectiveness is amply assured, and the selection of mutations that confer resistance is minimized according to the bibliography consulted. Patients who have taken levofloxacin from September 14, 2019, to October 31, 2019 are evaluated. They were grouped according to glomerular filtration: above 60 ml/min or normal renal function, GFR 40-60 ml/min, mild renal failure, GFR 20-40 ml/min moderate renal function, and GFR <20. The AUC/MIC is calculated with the prescribed dose, and the dose that would have been required to reach the exposure goal of 180 is estimated.

    Results: 122 patients were included. The mean creatinine clearance was 41.3ml/min, the mean age of the included patients 74.12 years. Mean dose was 500 mg and corresponds to a mean AUC of 51.3. By renal function groups, in GFR >60 ml/min, the mean dose would be 500 mg, mean AUC 42. GFR 40-60 ml/min, mean dose 500 mg and mean AUC 63. GFR 20-40 ml/min it would be a mean dose of 250mg AUC 134, and in GFR <20 it would be a mean dose of 250 mg and AUC 131.

    Conclusions: The data obtained from exposure (AUC) of levofloxacin in different types of patients, especially in patients with normal renal function, there is a high risk of underdosing at the usual doses, which may suggest problems of effectiveness and selection of resistant strains.