The effect of adsorption, filter material and point of dilution on antibiotic elimination by haemofiltration

Choi, Gordon; Gomersall, Charles D.; Lipman, Jeffrey; Wong, April S. Y.; Joynt, Gavin M.; Leung, Patricia; Ramsay, Sarah; Ho, Oi Man

doi:10.1016/j.ijantimicag.2004.06.005

Cited by 36 publications

(54 citation statements)

References 21 publications

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“…Validated ex vivo models using 1 L, continuously stirred, and citrate-anticoagulated bovine blood (Animal Technologies, Tyler, TX, USA) were used to assess drug clearances occurring when each CRRT model was performed in a randomized order of hemofilter types and flow rate combinations [11,12,13,14,15,16]. These models used standard commercial tubing sets; Braun Diapact CRRT System (B. Braun, Bethlehem, PA, USA) and Diapact CRRT Kit.…”

Section: Methodsmentioning

confidence: 99%

“…Adsorption/degradation experiments: adsorption experiments were performed to determine if the drugs adsorb to the hemofilters using a previously described ex vivo CHF modality [11,14]. For 1 h, commonly prescribed blood flow rates of 200 mL/min and ultrafiltrate rates of 33 mL/min were used to allow ceftolozane/tazobactam to be removed by the process of convection through the hemofilter membrane.…”

Section: Methodsmentioning

confidence: 99%

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Ex vivo Ceftolozane/Tazobactam Clearance during Continuous Renal Replacement Therapy

et al. 2017

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Background/Aims: To determine ceftolozane/tazobactam transmembrane clearances (CL_TM) in continuous hemofiltration (CHF) and continuous hemodialysis (CHD) and to determine optimal ceftolozane/tazobactam dosing regimens for patients receiving continuous renal replacement therapy (CRRT). Method: Validated, ex vivo CHF and CHD bovine blood models using polysulfone (HF1400) and AN69 (Multiflow 150-M) hemofilters were used to evaluate adsorption and CL_TM at different effluent flow rates. Monte Carlo simulations (MCS) using pharmacokinetic parameters from published studies and CL_TM from this study were used to generate ceftolozane/tazobactam dosing for patients receiving CRRT. Results: CHF and CHD CL_TM did not differ at equivalent effluent rates. CL_TM approximated effluent flow rates. No adsorption of ceftolozane/tazobactam occurred for either hemofilter. Effluent flow was the most important determinant of MCS-derived doses. Conclusion: CRRT clearances of ceftolozane/tazobactam depended on effluent flow rates but not hemofilter types. MCS-derived ceftolozane/tazobactam doses of 750 (500/250)-1,500 (1,000/500) mg every 8 h met pharmacodynamic targets for virtual patients receiving CRRT at contemporary effluent rates.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Ex vivo Ceftolozane/Tazobactam Clearance during Continuous Renal Replacement Therapy

et al. 2017

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“…The study used a previously described one-compartment model of CVVH to determine the adsorption of amikacin (3,19). The model involves filtration of a blood-crystalloid mixture of low hemoglobin concentration and low albumin concentration (to simulate the condition in critically ill patients) spiked with an appropriate amount of amikacin.…”

Section: Methodsmentioning

confidence: 99%

Adsorption of Amikacin, a Significant Mechanism of Elimination by Hemofiltration

Tian

Gomersall

et al. 2008

Antimicrob Agents Chemother

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We used an in vitro model of continuous venovenous hemofiltration (CVVH) to characterize amikacin adsorption by polyacrylonitrile (PAN) and polyamide filters. A blood-crystalloid mixture dosed with amikacin was pumped from a reservoir through a hemofiltration circuit and back to the reservoir. All ultrafiltrate was also returned to the reservoir. The level of adsorption was calculated from the fall in the amikacin concentration. The dose and the initial concentration of amikacin were varied, as were the pH, the type of hemofilter, and the hemofilter surface area. The reversibility of adsorption and the effect of repeated dosing were also studied. The level of adsorption by 0.6-m 2 PAN filters was significantly greater than that by 0.6-m 2 polyamide filters. Adsorption was increased by increasing the dose of amikacin even when the initial concentration was unchanged. It was unaffected by the pH (pH 6.8 or 7.4) or the hemofilter surface area (0.6 m 2 or 0.9 m 2 ). Repeated doses of amikacin resulted in further adsorption. In a saturation experiment, the maximum adsorptive capacity of 0.6-m 2 PAN hemofilters was at least 546.9 mg (range, 427.6 to 577.5 mg). The adsorption of amikacin by hemofilters is irreversible and was associated with the dose and the hemofilter material but not the hemofilter surface area. Close monitoring of peak amikacin levels should be considered for patients receiving CVVH with PAN hemofilters.

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“…Anionic drugs such as ceftazidime and cefotaxime may be repelled [22] . However, the clinical relevance of this effect is unclear [23,37,38] . Adsorption of antibacterials to the filter may also result in drug elimination.…”

Section: Pharmacokinetic Factorsmentioning

confidence: 99%

Principles of Antibacterial Dosing in Continuous Renal Replacement Therapy

et al. 2010

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Background: Appropriate antibacterial therapy is important to maximize patient survival in sepsis. Acute renal failure complicates optimal antibiotic administration. Methods: MEDLINE search from 1986 to 2010 using the terms ‘acute renal failure’, ‘pharmacokinetics’, ‘clearance’, ‘dosage’, ‘h(a)emofiltration’, ‘h(a)emodialysis’, ‘h(a)emodiafiltration’, ‘continuous renal replacement therapy’, ‘antibiotics’, ‘intensive care’ and ‘critically ill’. Results: Maximal bacterial killing and minimization of side effects depend on achieving pharmacokinetic targets appropriate to the selected antibacterial agent. Volume of distribution and clearance may be altered by critical illness and/or acute kidney injury. Clearance is determined by nonrenal clearance, residual renal clearance and continuous renal replacement therapy dose. Sieving and saturation coefficients are membrane specific, but may be altered by changes in protein binding induced by critical illness. A significant proportion of studies failed to report the essential dataset required for adequate antibacterial dosage calculation. Conclusions: Individualized dosing based on first principles may be the most appropriate method of dosing, particularly when enhanced by therapeutic drug monitoring.

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The effect of adsorption, filter material and point of dilution on antibiotic elimination by haemofiltration

Cited by 36 publications

References 21 publications

Ex vivo Ceftolozane/Tazobactam Clearance during Continuous Renal Replacement Therapy

Ex vivo Ceftolozane/Tazobactam Clearance during Continuous Renal Replacement Therapy

Adsorption of Amikacin, a Significant Mechanism of Elimination by Hemofiltration

Principles of Antibacterial Dosing in Continuous Renal Replacement Therapy

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