Dosing of daptomycin in intensive care unit patients with acute kidney injury undergoing extended dialysis--a pharmacokinetic study

Kielstein, Jan T.; Eugbers, Catrin; Bode-Boeger, Stefanie M.; Martens‐Lobenhoffer, Jens; Haller, Hermann; Joukhadar, Christian; Traunmüller, Friederike; Knitsch, Wolfgang; Hafer, Carsten; Burkhardt, Olaf

doi:10.1093/ndt/gfp704

Cited by 62 publications

(48 citation statements)

References 20 publications

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“…The present study suggests that ampicillin/sulbactam should be given 3 hours before ED (7). However, these same researchers recently studied daptomycin and a similar ED regimen, and they recommended that daptomycin administration should occur within 8 hours of ED (22). Gentamicin has been studied in ED, and the study suggested dosing immediately after ED (23).…”

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confidence: 78%

Adding to the Armamentarium

Mueller

Scoville

2012

Clinical Journal of the American Society of Nephrology

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confidence: 78%

Adding to the Armamentarium

Mueller

Scoville

2012

Clinical Journal of the American Society of Nephrology

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“…However, insufficient concentrations will result if the dose is administered during rather than after the dialysis treatment (44). In patients in intensive care, those undergoing extended dialysis should receive 6 mg/kg once daily to prevent suboptimal drug exposure, whereas those on continuous venovenous hemodialysis should receive 8 mg/kg every 48 h (45,46).…”

Section: Daptomycin Pharmacokineticsmentioning

confidence: 99%

A Current Perspective on Daptomycin for the Clinical Microbiologist

2013

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SUMMARY Daptomycin is a lipopeptide antimicrobial with in vitro bactericidal activity against Gram-positive bacteria that was first approved for clinical use in 2004 in the United States. Since this time, significant data have emerged regarding the use of daptomycin for the treatment of serious infections, such as bacteremia and endocarditis, caused by Gram-positive pathogens. However, there are also increasing reports of daptomycin nonsusceptibility, in Staphylococcus aureus and, in particular, Enterococcus faecium and Enterococcus faecalis . Such nonsusceptibility is largely in the context of prolonged treatment courses and infections with high bacterial burdens, but it may occur in the absence of prior daptomycin exposure. Nonsusceptibility in both S. aureus and Enterococcus is mediated by adaptations to cell wall homeostasis and membrane phospholipid metabolism. This review summarizes the data on daptomycin, including daptomycin's unique mode of action and spectrum of activity and mechanisms for nonsusceptibility in key pathogens, including S. aureus , E. faecium , and E. faecalis . The challenges faced by the clinical laboratory in obtaining accurate susceptibility results and reporting daptomycin MICs are also discussed.

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“…Ampicillin/ sulbactam (2 g/1 g) was infused intravenously in 12 patients over a period of 30 minutes using an infusion pump. ED was performed using the Genius batch dialysis system (Fresenius Medical Care, Bad Homburg, Germany) with a polysulfone high-flux dialyzer (F60S; surface area, 1.3 m 2 ) (Fresenius Medical Care) as described previously (12). The technical details of the system are explained elsewhere (17).…”

Section: Methodsmentioning

confidence: 99%

“…For the collection of the predialyzer and postdialyzer samples, ultrafiltration was stopped. Furthermore, in seven patients we took samples from the total spent dialysate after it was mixed by air insufflations as well as from the total collected ultrafiltrate, as described previously (12).…”

Section: Sampling and Analysismentioning

confidence: 99%

“…Moreover, in intensive care units (ICUs), extended dialysis (ED), a hybrid of continuous and intermittent renal replacement therapy (RRT), is increasingly used throughout the world (4-7). ED removes various antibiotics more efficiently compared with standard intermittent hemodialysis (IHD) three times a week or continuous RRT (8)(9)(10)(11)(12)(13), as very recently reviewed by Bogard et al (14). A single report from a patient with AKI suggests that higher doses of ampicillin/ sulbactam might also be necessary for critically ill patients treated with ED compared with intermittent hemodialysis (IHD) in the outpatient setting (15).…”

Section: Introductionmentioning

confidence: 99%

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Pharmacokinetics of Ampicillin/Sulbactam in Critically Ill Patients with Acute Kidney Injury undergoing Extended Dialysis

Lorenzen

Broll

Kaever

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives The fixed antibacterial combination of ampicillin and sulbactam is frequently used for various infections. Intact kidneys eliminate approximately 71% of ampicillin and 78% of sulbactam. Patients on thrice-weekly low-flux hemodialysis exhibit an ampicillin t 1/2 of 2.3 hours on and 17.4 hours off dialysis. Despite its frequent use in intensive care units, there are no available dosing recommendations for patients with AKI undergoing renal replacement therapy. The aims of this study were to evaluate the pharmacokinetics of ampicillin/ sulbactam in critically ill patients with AKI undergoing extended dialysis (ED) and to establish a dosing recommendation for this treatment method.Design, setting, participants, & measurements Twelve critically ill patients with anuric AKI being treated with ED were enrolled in a prospective, open-label, observational pharmacokinetic study. Pharmacokinetics after a single dose of ampicillin/sulbactam (2 g/1 g) was obtained in 12 patients. Multiple-dose pharmacokinetics after 4 days of twice-daily ampicillin/sulbactam (2 g/1 g) was obtained in three patients. ResultsThe mean dialyzer clearance for ampicillin/sulbactam was 80.167.7/83.3612.1 ml/min. The t 1/2 of ampicillin and sulbactam in patients with AKI undergoing ED were 2.860.8 hours and 3.561.5 hours, respectively. There was no significant accumulation using a twice-daily dosage of 2 g/1 g ampicillin/sulbactam.Conclusions Our data suggest that in patients treated with ED using a high-flux dialyzer (polysulphone, 1.3 m 2 ; blood and dialysate flow, 160 ml/min; treatment time, 480 minutes), a twice-daily dosing schedule of at least 2 g/1 g ampicillin/sulbactam, with one dose given after ED, should be used to avoid underdosing.

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Dosing of daptomycin in intensive care unit patients with acute kidney injury undergoing extended dialysis--a pharmacokinetic study

Cited by 62 publications

References 20 publications

Adding to the Armamentarium

Adding to the Armamentarium

A Current Perspective on Daptomycin for the Clinical Microbiologist

Pharmacokinetics of Ampicillin/Sulbactam in Critically Ill Patients with Acute Kidney Injury undergoing Extended Dialysis

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