Population pharmacokinetics of prophylactic cefoxitin in elective bariatric surgery patients: a prospective monocentric study
Authors' conclusion
Intermittent dosing regimens resulted in optimal FTAs against susceptible MIC distributions of S. aureus and E. coli when simulating with 50% cefoxitin protein binding. Continuous infusion of cefoxitin may improve FTA regardless of protein binding.
Study context
- Population
- Obese patients undergoing elective bariatric surgery receiving prophylactic cefoxitin381 concentration values
- Participants
- 123 patients
- Exposure
- Cefoxitin dosing regimens for target attainment
- Outcome
- Population PK of cefoxitin and probability of target attainment (cefoxitin fu above MIC from surgical incision to wound closure)
Methodological detailsmonocentric, dosing simulations
- Monocentric
- Dosing simulations
Main finding
As reported in the abstract
Cefoxitin population PK
- Mean clearance (L/h)
- 10.9 ± 6.1
- Mean volume of distribution (L)
- 23.4 ± 10.5
- Surgery <2 h: 2 g dose sufficient for minimum inhibitory concentrations (MIC) up to 4 mg/L (fu 50%)
- 4
- Surgery <2 h: 4 g dose sufficient for MIC up to 8 mg/L (fu 50%)
- 8
- Prolonged surgery (2-4 h): only continuous infusion enabled optimal probability of target attainment (PTA) for MIC up to 16 mg/L
- 16
Observational data: associations, not effects.
Further findings
Fractional target attainment (FTA) against S. aureus and E. coli MIC distributions
- Optimal FTAs only with 50% protein binding (intermittent regimen) and regardless of protein binding for continuous infusion
Original publication
Population pharmacokinetics of prophylactic cefoxitin in elective bariatric surgery patients: a prospective monocentric study. Anaesth Crit Care Pain Med. Published 15 March 2024. doi:10.
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