Most adult patients receiving extracorporeal membrane oxygenation (ECMO) require antibiotic therapy, however the pharmacokinetics of beta-lactams have not been well studied in these conditions. In this study, data from all patients receiving ECMO support and meropenem (MEM) or piperacillin/tazobactam (TZP) were reviewed. Drug concentrations were measured 2 h after the start of a 30-min infusion and just before the subsequent dose. Therapeutic drug monitoring (TDM) results in ECMO patients were matched with those in non-ECMO patients for (i) drug regimen, (ii) renal function, (iii) total body weight, (iv) severity of organ dysfunction and (v) age. Drug concentrations were considered adequate if they remained 4-8x the clinical MIC breakpoint for Pseudomonas aeruginosa for 50% (TZP) or 40% (MEM) of the dosing interval. A total of 41 TDM results (27 MEM; 14 TZP) were obtained in 26 ECMO patients, with 41 matched controls. There were no significant differences in serum concentrations or pharmacokinetic parameters between ECMO and non-ECMO patients, including V-d[0.38(0.27-0.68) vs. 0.46(0.33-0.79) L/kg; P=0.37], half-life [2.6(1.8-4.4) vs. 2.9(1.7-3.7) h; P=0.96] and clearance [132(66-200) vs. 141 (93-197) mL/min; P=0.52]. The proportion of insufficient (13141 vs. 12141), adequate (15141 vs. 19141) and excessive (13141 vs. 10141) drug concentrations was similar in ECM and non-ECMO patients. Achievement of target concentrations of these beta-lactams was poor in ECMO and non-ECMO patients. The influence of ECMO on MEM and TZP pharmacokinetics does not appear to be significant.
Donadello, K., Antonucci, E., Cristallini, S., Roberts, J.A., Beumier, M., Scolletta, S., et al. (2015). β-Lactam pharmacokinetics during extracorporeal membrane oxygenation therapy: A case-control study. INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS, 45(3), 278-282 [10.1016/j.ijantimicag.2014.11.005].
β-Lactam pharmacokinetics during extracorporeal membrane oxygenation therapy: A case-control study
SCOLLETTA, SABINO;
2015-01-01
Abstract
Most adult patients receiving extracorporeal membrane oxygenation (ECMO) require antibiotic therapy, however the pharmacokinetics of beta-lactams have not been well studied in these conditions. In this study, data from all patients receiving ECMO support and meropenem (MEM) or piperacillin/tazobactam (TZP) were reviewed. Drug concentrations were measured 2 h after the start of a 30-min infusion and just before the subsequent dose. Therapeutic drug monitoring (TDM) results in ECMO patients were matched with those in non-ECMO patients for (i) drug regimen, (ii) renal function, (iii) total body weight, (iv) severity of organ dysfunction and (v) age. Drug concentrations were considered adequate if they remained 4-8x the clinical MIC breakpoint for Pseudomonas aeruginosa for 50% (TZP) or 40% (MEM) of the dosing interval. A total of 41 TDM results (27 MEM; 14 TZP) were obtained in 26 ECMO patients, with 41 matched controls. There were no significant differences in serum concentrations or pharmacokinetic parameters between ECMO and non-ECMO patients, including V-d[0.38(0.27-0.68) vs. 0.46(0.33-0.79) L/kg; P=0.37], half-life [2.6(1.8-4.4) vs. 2.9(1.7-3.7) h; P=0.96] and clearance [132(66-200) vs. 141 (93-197) mL/min; P=0.52]. The proportion of insufficient (13141 vs. 12141), adequate (15141 vs. 19141) and excessive (13141 vs. 10141) drug concentrations was similar in ECM and non-ECMO patients. Achievement of target concentrations of these beta-lactams was poor in ECMO and non-ECMO patients. The influence of ECMO on MEM and TZP pharmacokinetics does not appear to be significant.File | Dimensione | Formato | |
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https://hdl.handle.net/11365/982817