Anti-infective drugs during continuous hemodialysis - using the bench to learn what to do at the bedside

Roehr, Anka C., Frey, Otto R., Koeberer, Andreas, Fuchs, Thomas, Roberts, Jason A. and Brinkmann, Alexander (2015) Anti-infective drugs during continuous hemodialysis - using the bench to learn what to do at the bedside. International Journal of Artificial Organs, 38 1: 17-22. doi:10.5301/ijao.5000377

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Author Roehr, Anka C.
Frey, Otto R.
Koeberer, Andreas
Fuchs, Thomas
Roberts, Jason A.
Brinkmann, Alexander
Title Anti-infective drugs during continuous hemodialysis - using the bench to learn what to do at the bedside
Journal name International Journal of Artificial Organs   Check publisher's open access policy
ISSN 0391-3988
Publication date 2015-01
Sub-type Article (original research)
DOI 10.5301/ijao.5000377
Open Access Status Not yet assessed
Volume 38
Issue 1
Start page 17
End page 22
Total pages 6
Place of publication Milan, MI, Italy
Publisher Wichtig Publishing
Collection year 2016
Language eng
Formatted abstract
Purpose: The main objective of this study was to investigate the clearance of 11 selected anti-infectives in an in vitro model of continuous veno-venous hemodialysis (CVVHD), in order to suggest rational dosing strategies for clinical practice.

Methods: Ceftazidime, ciprofloxacin, flucloxacillin, gentamicin, linezolid, meropenem, metronidazole, piperacillin, rifampicin, vancomycin and voriconazole were studied in two different solvents (sodium chloride 0.9% and HSA 5%) using a multifiltrate dialysis device by Fresenius Medical Care (Bad Homburg, Germany). For each solution, prefilter, postfilter, and dialysate samples were drawn simultaneously during one hour of dialysis and were assayed.

Results: The clearance of all drugs except rifampicin in sodium chloride 0.9% was comparable (mean 1.76 ± 0.11 l/h). The clearance of these agents in human serum albumin solution 5% was reduced by between 5.3% and 72.2%. The unbound drug fraction correlated with a lower clearance in HSA 5% (Pearson correlation coefficient r = 0.933; p = 0.00008). No correlation between clearance in HSA 5% and the drugs’ molecular weight was found (Pearson correlation coefficient r = 0.388; p = 0.268). Rifampicin was detected to bind to the surface of the polysulfone filter used. Dialysis clearance of ceftazidime, gentamicin, linezolid, meropenem, metronidazole, piperacillin and vancomycin during CVVHD accounted for over 25% of the total body clearance of population pharmacokinetic data for renally impaired patients.

Conclusions: The results from this study highlight that dose adaptations are needed for most of the drugs under investigation for patients undergoing CVVHD. In combination with polysulfone filters, rifampicin should be used with care in this setting.
Keyword Anti-bacterial agents
Renal replacement therapy
In vitro
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Medicine Publications
School of Pharmacy Publications
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Citation counts: TR Web of Science Citation Count  Cited 2 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 2 times in Scopus Article | Citations
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