Pharmacokinetic longitudinal studies of antibiotics administered via a permanent intraosseous device in micropigs

Background. In critically ill children, intraosseous (IO) administration of a medicine provides an alternate Vascular access route when IV access is n ot readily available. We investigated the short and long-term efficacy and safety of a totally intraosseously implantable device. Procedure. This stud y was undertaken in micropigs (i) to compare serum levels achieved by equal bolus dosages of two antibiotics (amikacin and vancomycin) administered th rough an intratibial needle, an intraosseous implantable device and central IV routes to determine whether standard parenteral dosing guidelines for a ntibiotics may be applied without modification for IO injection, and (ii) t o show the efficiency of the implantable device over a prolonged period, as a permanent access to intraosseous space. Results. The area under the plas ma concentration time curves were similar for IV, intratibial and through t he intraosseous implantable device, for intermittent administrations of ami kacin and vancomycin, over a period of 6 months. However, vancomycin did no t reach therapeutic levels via both IO routes. We did not fi nd any alterat ion of amikacin and vancomycin pharmacokinetics over a period of 6 months u sing the implantable device. No complication occurred. Conclusions. Long-te rm administration of antibiotics through a totally implantable intraosseous device is feasible and safe in micropigs. Although the procedure seems pro mising, additional studies of the continuous infusion oi chemotherapeutic a gents, blood products and antimicrobial solutions are needed prior to use i n humans, (C) 2001 Wiley-Liss, Inc.