Risk of underdosing of ampicillin/sulbactam in patients with acute kidney injury undergoing extended daily dialysis—a single case

Abstract

The fixed antibacterial combination of ampicillin and sulbactam is frequently used for various infections. The normal kidneys eliminate approximately 60% of ampicillin (371.39 Da) and sulbactam (255.22 Da). Concomitant with the decline in renal function, the terminal elimination half-life increases from 1 up to 24 h in patients with ESRD. Patients on three times weekly low flux haemodialysis exhibit a half-life of 2.3 h on and 17.4 h off dialysis. In contrast, in the present observation the elimination half-life in a single patient with acute kidney injury undergoing extended daily dialysis (EDD) with a polysulphone membrane was 1.5 h, indicating that the current dosing regimen for haemodialysis outpatients (ampicillin/sulbactam 2.0/1.0 g/day) would result in a significant underdosing for patients undergoing EDD.

Drug dosing consideration in patients with acute and chronic kidney disease—a clinical update from Kidney Disease: Improving Global Outcomes (KDIGO)

“…To date, hybrid RRT PK data have been published for only 12 drugs. [126][127][128][129][130][131][132][133][134][135][136][137][138][139] Assessment of the impact of CRRT and hybrid RRT CRRT parameters substantially influence drug clearance. The mode of therapy (diffusion, convection, or both) can be influential, as both therapy modes can remove small solutes, but convective therapies are superior at removing larger solutes.…”

Diagnosis, prevention and treatment of haemodialysis catheter-related bloodstream infections (CRBSI): a position statement of European Renal Best Practice (ERBP)

“…Highly efficient dialysis strategies (highflux haemodialysis, haemodiafiltration, daily dialysis, prolonged dialysis sessions such as in nocturnal dialysis) can equally remove substantial amounts of antibiotic [79], and also in these cases the dose should be adapted accordingly. To guide treatment, pre-dialysis trough levels are the optimal approach.…”

Principles of Drug Dosing in Sustained Low Efficiency Dialysis (SLED) and Review of Antimicrobial Dosing Literature

“…A case was published of a patient that received a single dose of ampicillin/sulbactam for an Enterococcus faecalis (MIC < 2) urinary tract infection while on SLED [19]. A dose of 3 g (ampicillin 2 g/sulbactam 1 g) was administered over 30 min and multiple plasma samples were drawn prior to the dose and up to 12 h after the initiation of the infusion.…”