Cotrimoxazole in the intensive care unit: an impossible task for the fixed association in real life?

Auteurs

Launay M, Pina M, Guilhaumou R, Bruna F, Thiery G, Perinel Ragey S

Les auteurs en lien sont membres de l'INS.

Équipes

TNG

Résumé

Abstract Background Cotrimoxazole (trimethoprim/sulfamethoxazole) is a widely used antibiotic in ICU for the treatment of infections such as nosocomial or Pneumocystis jirovecii pneumonia. However, dosing in ICU patients is complicated by fluctuations in renal function, particularly acute kidney injury and augmented renal clearance, which affect drug elimination. This study investigated how renal function and body weight influence trimethoprim and sulfamethoxazole concentrations. Patients and methods This retrospective bicentre observational study involved 116 ICU patients receiving cotrimoxazole therapy with routine therapeutic drug monitoring. The study focused on effects of estimated glomerular filtration rate (eGFR) and weight on concentrations and dosing. Results Dosing of sulfamethoxazole and trimethoprim was significantly lower in patients with eGFR <30 mL/min/1.73 m2, as recommended. In these patients, sulfamethoxazole concentrations were reduced, suggesting underdosing, while trimethoprim increased with worsening renal function, indicating overdose risk when eGFR <60 mL/min/1.73 m2. Patients on renal replacement therapy (RRT) had lower sulfamethoxazole concen

Abstract Background Cotrimoxazole (trimethoprim/sulfamethoxazole) is a widely used antibiotic in ICU for the treatment of infections such as nosocomial or Pneumocystis jirovecii pneumonia. However, dosing in ICU patients is complicated by fluctuations in renal function, particularly acute kidney injury and augmented renal clearance, which affect drug elimination. This study investigated how renal function and body weight influence trimethoprim and sulfamethoxazole concentrations. Patients and methods This retrospective bicentre observational study involved 116 ICU patients receiving cotrimoxazole therapy with routine therapeutic drug monitoring. The study focused on effects of estimated glomerular filtration rate (eGFR) and weight on concentrations and dosing. Results Dosing of sulfamethoxazole and trimethoprim was significantly lower in patients with eGFR <30 mL/min/1.73 m2, as recommended. In these patients, sulfamethoxazole concentrations were reduced, suggesting underdosing, while trimethoprim increased with worsening renal function, indicating overdose risk when eGFR <60 mL/min/1.73 m2. Patients on renal replacement therapy (RRT) had lower sulfamethoxazole concen

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