Hanretty Alexandra M, Moore Wayne S, Chopra Arun, Cies Jeffrey J
J Pediatr Pharmacol Ther. 2020;25(3):261-265. doi: 10.5863/1551-6776-25.3.261.
To describe the pharmacokinetics of levofloxacin in an obese adolescent patient in the pediatric intensive care unit.
A single-patient medical record review was conducted.
A 168-kg, 15-year-old female with past medical history of Prader-Willi syndrome and asthma initially presented with respiratory distress secondary to asthma exacerbation. She failed non-invasive ventilation and was subsequently intubated for respiratory failure and progressed to high-frequency oscillatory ventilation. On hospital day 1 (HD 1) an infectious workup was begun because of a fever, worsening clinical status, and initiation of vasopressors and an empiric antimicrobial regimen of cefepime and clindamycin. The urine culture subsequently grew Escherichia coli and the respiratory culture grew Pseudomonas aeruginosa. She continued to be febrile, which was thought to be due to an intra-abdominal abscess. On HD 14, the antimicrobial regimen was changed to levofloxacin because of continued fevers and no significant clinical improvement. Levofloxacin was initiated at 1000 mg IV every 24 hours. Levofloxacin serum levels were obtained at 0.5, 3.5, and 11.5 hours after infusion, which were 8.61, 5.76, and 2.7 mg/L, respectively. These concentrations translated into a peak level of 8.79 mg/L, a half-life of 6.4 hours, and an AUC of 80 mg·hr/L, which are discordant from the expected peak of 16 mg/L, a half-life of 8 hours, and an AUC of 120 mg·hr/L. Based on these values, the levofloxacin regimen was adjusted to 1000 mg IV every 12 hours, and repeat levels 0.5, 3.5, and 11.5 hours after infusion were 9.91, 6.56, and 3.27 mg/L, respectively, corresponding to a peak of 10.5 mg/L, a half-life of 5.18 hours, and an AUC of 200 mg·hr/L. After the adjustment in levofloxacin regimen, she became afebrile, WBC resolution and improvement in her overall clinical status, and she received a total duration for levofloxacin of 21 days.
A levofloxacin regimen of 1000 mg IV every 12 hours was successful in providing for an appropriate AUC exposure and was associated with a successful clinical outcome in this morbidly obese adolescent.
描述左氧氟沙星在儿科重症监护病房一名肥胖青少年患者体内的药代动力学。
进行了单病例病历回顾。
一名体重168千克、15岁的女性，既往有普拉德-威利综合征和哮喘病史，最初因哮喘加重出现呼吸窘迫。她无创通气失败，随后因呼吸衰竭插管，并进展为高频振荡通气。在住院第1天（HD 1），由于发热、临床状况恶化以及开始使用血管升压药，开始进行感染方面的检查，并给予头孢吡肟和克林霉素经验性抗菌治疗。随后尿培养生长出大肠杆菌，呼吸道培养生长出铜绿假单胞菌。她持续发热，被认为是由于腹腔脓肿所致。在HD 14，由于持续发热且临床无明显改善，抗菌治疗方案改为左氧氟沙星。左氧氟沙星起始剂量为静脉注射1000毫克，每24小时一次。在输注后0.5、3.5和11.5小时获取左氧氟沙星血清水平，分别为8.61、5.76和2.7毫克/升。这些浓度对应的峰浓度为8.79毫克/升，半衰期为6.4小时，AUC为80毫克·小时/升，与预期的峰浓度16毫克/升、半衰期8小时和AUC 120毫克·小时/升不一致。基于这些值，将左氧氟沙星治疗方案调整为静脉注射1000毫克，每12小时一次，输注后0.5、3.5和11.5小时重复检测的水平分别为9.91、6.56和3.27毫克/升，对应的峰浓度为10.5毫克/升，半衰期为5.18小时，AUC为200毫克·小时/升。调整左氧氟沙星治疗方案后，她体温恢复正常，白细胞恢复正常，整体临床状况改善，左氧氟沙星总疗程为21天。
静脉注射左氧氟沙星1000毫克，每12小时一次的治疗方案成功提供了合适的AUC暴露，并与这名病态肥胖青少年的临床成功结局相关。
