Evaluation of intraosseous vs intravenous antibiotic levels in a porcine model
D. G. Jaimovich, A. Kumar and S. Francom
Department of Pediatrics, University of Illinois, Chicago 60612.
OBJECTIVES. To compare intraosseous vs intravenous routes of administration
and their effects on serum levels of four antibiotics in an animal model.
DESIGN. Prospective controlled study comparing two routes of drug
administration. SETTING. Research laboratories of a large pharmaceutical
company. PARTICIPANTS. Twenty male and female domestic swine weighing 10 to
20 kg. INTERVENTIONS. The animals were anesthetized and treated with
controlled ventilation. The animals were divided into one of four groups:
(1) intravenous and intraosseous cefotaxime sodium (50 mg/kg), (2)
intravenous and intraosseous chloramphenicol sodium succinate (25 mg/kg),
(3) intravenous and intraosseous vancomycin hydrochloride (15 mg/kg), or
(4) intravenous and intraosseous tobramycin sulfate (2.5 mg/kg). There was
a 24-hour clearance period for groups 1 and 2 and a 48-hour clearance
period for groups 3 and 4. Serum drug levels were measured at 1, 15, 30,
45, 60, 90, and 120 minutes after intravenous and intraosseous
administration of the respective antibiotics. Control and treated tibias
were sampled for drug levels at the end of the experiment. MEASUREMENTS AND
MAIN RESULTS. - Peak serum concentrations for intravenously administered
antibiotics were within the therapeutic range. Peak serum levels after
intravenous and intraosseous administration were 102 and 82 mg/L,
respectively for cefotaxime; 13.9 and 6.3 mg/L, respectively, for
chloramphenicol; 24.5 and 3.8 mg/L, respectively, for vancomycin; and 7.1
and 1.3 mg/L, respectively, for tobramycin. CONCLUSIONS. Cefotaxime may be
administered intraosseously when intravenous access is not possible. We
cannot recommend chloramphenicol or vancomycin for intraosseous
administration, because serum levels were not comparable with those
following intravenous administration. Findings with tobramycin suggested a
lack of achievement of serum levels comparable with those following
intravenous administration.
