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Leanza GM, Liguoro B, Giuliano S, Moreal C, Montanari L, Angelini J, Cai T, Murri R, Tascini C. The Subcutaneous Administration of Beta-Lactams: A Case Report and Literary Review-To Do Small Things in a Great Way. Infect Dis Rep 2024; 16:93-104. [PMID: 38391585 PMCID: PMC10887887 DOI: 10.3390/idr16010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 02/24/2024] Open
Abstract
The subcutaneous (s.c.) route is a commonly used method for delivering various drugs, although its application in the administration of antibiotics is relatively uncommon. In this case, we report a successful treatment of nosocomial pneumonia using piperacillin/tazobactam via continuous subcutaneous administration. Furthermore, this article provides an overview of the current literature regarding the s.c. administration of beta-lactam antibiotics. Based on our analysis, we identified only 15 studies that described the s.c. use of beta-lactam antibiotics in human subjects. Among these studies, cephalosporins were the most extensively investigated antibiotic class, with 10 available studies. According to the study findings, all three antibiotic classes (cephalosporins, penicillins, and carbapenems) demonstrated a similar pharmacokinetic profile when administered via the subcutaneous route. The subcutaneous route appears to be associated with a lower peak serum concentration (Cmax) but a comparable minimum blood concentration (Cmin) and an extended half-life (t1/2) when compared to conventional routes of antibiotic administration. Further research is necessary to determine whether subcutaneously administered beta-lactam antibiotics in human subjects achieve pharmacodynamic targets and demonstrate clinical efficacy.
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Affiliation(s)
- Gabriele Maria Leanza
- Dipartimento di Sicurezza e Bioetica, Università Cattolica del S. Cuore, 00168 Rome, Italy
| | - Beatrice Liguoro
- Dipartimento di Sicurezza e Bioetica, Università Cattolica del S. Cuore, 00168 Rome, Italy
| | - Simone Giuliano
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Chiara Moreal
- Infectious Diseases Clinic, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Luca Montanari
- Infectious Diseases Clinic, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Jacopo Angelini
- Pharmacology Institute, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Tommaso Cai
- Department of Urology, Santa Chiara Regional Hospital, 38123 Trento, Italy
- Institute of Clinical Medicine, University of Oslo, 0315 Oslo, Norway
| | - Rita Murri
- Dipartimento di Sicurezza e Bioetica, Università Cattolica del S. Cuore, 00168 Rome, Italy
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Carlo Tascini
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), 33100 Udine, Italy
- Infectious Diseases Clinic, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
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Ferry T, Lodise TP, Gallagher JC, Forestier E, Goutelle S, Tam VH, Mohr JF, Roubaud-Baudron C. Outpatient Subcutaneous Antimicrobial Therapy (OSCAT) as a Measure to Improve the Quality and Efficiency of Healthcare Delivery for Patients With Serious Bacterial Infections. Front Med (Lausanne) 2020; 7:585658. [PMID: 33425938 PMCID: PMC7785854 DOI: 10.3389/fmed.2020.585658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/24/2020] [Indexed: 11/13/2022] Open
Abstract
Since the 1970s, outpatient parenteral antimicrobial therapy (OPAT) has been a viable option for patients who require intravenous antibiotics when hospitalization is not warranted. While the benefits of OPAT as a measure to improve the efficiency of healthcare delivery (i.e., reduced hospital days) and patient satisfaction are well-documented, OPAT is associated with a number of challenges, including line complications and reliance on daily healthcare interactions in some cases at home or in a clinic. To minimize the continued need for intensive healthcare services in the outpatient setting, there is trend toward patients self-administering antibiotics at home without the presence of healthcare workers, after adequate training. In most cases, patients administer the antibiotics through an established intravenous catheter. While this OPAT practice is becoming more accepted as a standard of care, the potential for line complications still exists. Outpatient subcutaneous antimicrobial therapy (OSCAT) has become an increasingly accepted alternative route of administration of antibiotics to IV by French infectious diseases physicians and geriatricians; however, currently, no antibiotics are approved to be administered subcutaneously. Antibiotics with longer half-lives that are completely absorbed and have a favorable local tolerability profile are ideal candidates for OSCAT and have the potential to maximize the quality and efficiency of parenteral antibiotic delivery in the outpatient setting. The increasing development of wearable, on-body subcutaneous delivery systems make OSCAT even more viable as they increase patient independence while avoiding line complications and potentially removing the need for direct healthcare professional observation.
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Affiliation(s)
- Tristan Ferry
- Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France.,Centre interrégional de référence pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,CIRI - Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
| | - Thomas P Lodise
- Albany College of Pharmacy and Health Sciences, Albany, NY, United States
| | - Jason C Gallagher
- Department of Pharmacy Practice, Temple University, Philadelphia, PA, United States
| | - Emmanuel Forestier
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier de Métropole Savoie, Chambéry, France
| | - Sylvain Goutelle
- Pharmacie hospitalière, Hospices Civils de Lyon, Groupement Hospitalier Nord, Lyon, France.,Univ Lyon, Université Lyon 1, UMR CNRS 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France
| | - Vincent H Tam
- Department of Pharmacy Practice and Translational Research, University of Houston, Houston, TX, United States
| | - John F Mohr
- scPharmaceuticals, Burlington, MA, United States
| | - Claire Roubaud-Baudron
- CHU de Bordeaux, Pôle de Gérontologie Clinique, Bordeaux, France.,Univ. Bordeaux, INSERM UMR 1053 BaRITOn, Bordeaux, France
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Michelon H, Tardivel M, Dinh A, Alvarez JC, Salomon E, Le Quintrec JL, Hirt D, Davido B. Efficacy and safety of subcutaneous administration of ceftazidime as a salvage therapy in geriatrics: a case report. Fundam Clin Pharmacol 2019; 34:521-524. [PMID: 31709583 DOI: 10.1111/fcp.12520] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/30/2019] [Accepted: 11/07/2019] [Indexed: 12/22/2022]
Abstract
Ceftazidime is a third-generation cephalosporin used for the treatment of Gram-negative bacteria only approved for parenteral use by intravenous and intramuscular route. In some clinical situations, off-label subcutaneous injection could be a salvage route for the administration of antibiotics, especially in geriatrics, despite the paucity of evidence about efficacy and safety. We report a case of a successful and well-tolerated subcutaneous ceftazidime therapy in a 90-year-old woman for the treatment of an acute urinary tract infection caused by Pseudomonas aeruginosa with therapeutic drug monitoring data.
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Affiliation(s)
- Hugues Michelon
- Service de Pharmacie, Hôpitaux Universitaires Paris Ile-de-France Ouest, Site Sainte-Périne, AP-HP, 11 rue Chardon Lagache, Paris, 75016, France
| | - Marie Tardivel
- Service de Médecine Gériatrique, Hôpitaux Universitaires Paris Ile-de-France Ouest, Site Sainte-Périne, AP-HP, 11 rue Chardon Lagache, Paris, 75016, France
| | - Aurélien Dinh
- Service de Maladies Infectieuses, Hôpitaux Universitaires Paris Ile-de-France Ouest, site Raymond Poincaré, AP-HP, 104 Bd Raymond Poincaré, Garches, 92380, France
| | - Jean-Claude Alvarez
- Service de Pharmacologie - Toxicologie, Hôpitaux Universitaires Paris Ile-de-France Ouest, site Raymond Poincaré, AP-HP, 104 Bd Raymond Poincaré, Garches, 92380, France
| | - Elsa Salomon
- Service de Microbiologie, Hôpitaux Universitaires Paris Ile-de-France Ouest, Site Ambroise Paré, AP-HP, 9 avenue Charles de Gaulle, Boulogne-Billancourt, 94104, France
| | - Jean-Laurent Le Quintrec
- Service de Médecine Gériatrique, Hôpitaux Universitaires Paris Ile-de-France Ouest, Site Sainte-Périne, AP-HP, 11 rue Chardon Lagache, Paris, 75016, France
| | - Deborah Hirt
- Service de Pharmacologie Clinique, Groupe Hospitalier Paris Centre, Site Cochin, AP-HP, 27 rue du Faubourg Saint Jacques, Paris, 75014, France
| | - Benjamin Davido
- Service de Maladies Infectieuses, Hôpitaux Universitaires Paris Ile-de-France Ouest, site Raymond Poincaré, AP-HP, 104 Bd Raymond Poincaré, Garches, 92380, France
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Duron D, Chanoine S, Peron M, Lepelley M, Allenet B, Epaulard O, Camara B, Bedouch P. A successful antibiotic treatment by a new administration route: a case report of a subcutaneous administration of ceftazidime and tobramycin. Fundam Clin Pharmacol 2019; 33:703-706. [PMID: 31038766 DOI: 10.1111/fcp.12477] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/13/2019] [Accepted: 04/25/2019] [Indexed: 11/30/2022]
Abstract
When intramuscular or intravenous administrations of parenteral drugs are not possible, the use of other routes (e.g., subcutaneous route) should be considered. We report a patient with Duchenne muscular dystrophy, who was hospitalized for acute pneumonia due to antibiotic-resistant strains of bacteria. Our patient was successfully recovered with antimicrobial therapy by subcutaneous administration of ceftazidime and tobramycin, for which no safety and efficacy data are available in humans. To the best of our knowledge, this case is the first supporting the subcutaneous administration safety and potential efficacy of both ceftazidime and tobramycin in humans.
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Affiliation(s)
- Dorothée Duron
- Pôle Pharmacie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble 38000, France
| | - Sébastien Chanoine
- Pôle Pharmacie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble 38000, France.,Université Grenoble Alpes, Grenoble 38000, France.,CR UGA/Inserm 1209/CNRS UMR 5309, Institute for Advanced Biosciences, Grenoble 38000, France
| | - Maud Peron
- Pôle Pharmacie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble 38000, France
| | - Marion Lepelley
- Centre Régional de Pharmacovigilance, Grenoble 38000, France
| | - Benoît Allenet
- Pôle Pharmacie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble 38000, France.,Université Grenoble Alpes, Grenoble 38000, France.,TIMC-IMAG UMR 5525/ThEMAS, CNRS, Grenoble 38000, France
| | - Olivier Epaulard
- Université Grenoble Alpes, Grenoble 38000, France.,Clinique Universitaire des Maladies infectieuses et tropicales, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble 38000, France
| | - Boubou Camara
- Service Hospitalier Universitaire de Pneumologie-Physiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble 38000, France
| | - Pierrick Bedouch
- Pôle Pharmacie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble 38000, France.,Université Grenoble Alpes, Grenoble 38000, France.,TIMC-IMAG UMR 5525/ThEMAS, CNRS, Grenoble 38000, France
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