Intraosseous and intravenous administration of antibiotics yields comparable plasma concentrations during experimental septic shock

Abstract

BackgroundWe aimed to investigate whether comparable antibiotic concentrations could be reached with intraosseous and intravenous administration during septic shock.MethodsIn this randomized, prospective experimental study conducted at an animal research laboratory at the University Hospital of Uppsala, eight anesthetized pigs, weighing 21.2 to 29.1 kg (mean: 25.2 ± 2.3 kg), received endotoxin infusion at 4 μg/kg/h for 6 h. At the onset of clinical shock, alternatively after 3 h of endotoxemia, they received 75 mg/kg of cefotaxime and 7 mg/kg of gentamicin either in a proximal tibial intraosseous catheter or in a peripheral intravenous catheter. Mixed venous samples were taken after 5, 15, 30, 60, 120 and 180 min and analyzed for antibiotic concentrations.ResultsFor both antibiotics, plasma concentrations after intraosseous and intravenous administration followed similar curves throughout the observation period, and peak concentrations were comparable. Mean concentration area under the curve (AUC mg × h/l) for cefotaxime was 108.1 ± 19.5 after intraosseous and 116.5 ± 11.1 after intravenous administration; ratio 0.93, (95% CI 0.71–1.19). Mean AUC for gentamicin was 28.1 ± 6.8 for intraosseous and 32.2 ± 3.5 for intravenous administration; ratio 0.87 (95% CI 0.62–1.19).ConclusionsIn this porcine septic shock model, intraosseous and intravenous administration of gentamicin and cefotaxime yielded comparable concentrations. In an emergency, intraosseous administration of these antibiotics may be considered in severe infections when venous access is difficult.

Intraosseous access can be taught to medical students using the four-step approach

“…The IO needle insertion has few associated risks, a high operator satisfaction and a high rate of success even for the inexperienced clinician [ 3 , 6 – 10 ]. Furthermore, substances injected by the IO route achieve adequate plasma concentrations in a time comparable with vascular access [ 11 – 14 ].…”

Use of intra-osseous access in adults: a systematic review

“…Time to peak blood concentration and total delivered dose were similar for sternal IO and central venous administration [ 39 ]. In a recent study with a porcine septic shock model, the concentration of antibiotics was similar between IO access and peripheral IV access [ 40 ]. In the sole study in adults, pharmacokinetic parameters were similar after IO or IV administration of a single 5 mg bolus of morphine sulfate using IO access implanted in iliac crest [ 41 ].…”

Poly(methyl methacrylate) Bone Cement Composite Can Be Refilled with Antibiotics after Implantation in Femur or Soft Tissue

“…Oftentimes, much of the drug added initially can remain entrapped in the PMMA permanently with one study showing upwards of 85% of drug remaining trapped over an extended period of time [ 16 ]. In conjunction with the antibiotic-filled PMMA, additional antibiotics may be administered either intravenously or intraosseously to treat PJIs and orthopedic infections in an effort to supplement the poor antibiotic release kinetics from PMMA [ 17 , 18 , 19 ]. Intraosseous (IO) infusion offers a unique advantage over traditional intravenous administration as it can provide a higher local tissue antibiotic concentration while reducing off-target systemic effects [ 17 ].…”