Vancomycin pharmacokinetics in critically ill patients receiving continuous haemodiafiltration with a polyethyleneimine‐coated polyacrylonitrile membrane

Abstract

What is known and objective We investigated the elimination efficiency and pharmacokinetics (PK) parameters of vancomycin (VCM) in patients undergoing continuous haemodiafiltration (CHDF) using a polyethyleneimine‐coated polyacrylonitrile membrane (AN69ST) for dosage adjustment. Methods We conducted a retrospective study of CHDF patients treated with VCM from December 2017 to August 2019. We calculated PK parameters of VCM and determined the 24‐hour dose required to maintain the target trough concentration of VCM (VCM_trough). Results and discussion The average (95% CI) volume of distribution and total clearance of VCM were 75.5 L (63.7‐87.3 L) and 1.84 L/h (1.38‐2.30 L/h), respectively, and the elimination rate constant and half‐life were 0.026/h (0.017‐0.034/h) and 31.2 h (22.8‐39.5 h), respectively. The average AN69ST clearance of VCM (CL_CHDF) was 0.69 L/h (0.52‐0.86 L/h). The estimated average doses required to maintain VCM_trough of 10, 15 and 20 μg/mL were 623.1 mg (379.8‐866.4 mg), 934.6 mg (569.7‐1299.5 mg) and 1246.2 mg (759.6‐1732.8 mg), respectively. What is new and conclusion The PK of VCM and CL_CHDF of AN69ST were clarified. These results suggest that it is possible to adjust the dose of VCM in using AN69ST, which efficiently removes cytokines, and contributes to improvement of serious infections.

Contribution of diafiltration and adsorption to vancomycin clearance in a continuous hemodiafiltration circuit model in vitro

“…However, it was suggested that diafiltration mainly contributes to CL CHDF of VCM after 10 min (Figure 3B,D), which was supported by our results showing that total CL CHDF depended on Qe, and the average diafiltration rate at 3 h was over 80% (Table 1). It has been reported that the average AN69ST‐CHDF clearance of VCM in vivo under conditions similar to those of the present study (i.e., average Qb of 99 mL/min, Qd of 500 mL/h, Qf of 375 mL/h, and median albumin value of 2.5 g/dL) was 0.69 L/h 30 . The results of this previous study were similar to those of the present study (Table 1), indicating that our in vitro circuit model could reflect in vivo conditions well.…”

“…Some in vitro studies of the CHF circuit have revealed the adsorption of VCM on AN69 or AN69ST membranes 20,21,29 . Although the CL CHDF of VCM using AN69ST in vivo was recently reported, 30 the contribution of diafiltration and adsorption under the CHDF circuit on VCM clearance has not yet been clarified, either in vitro or in vivo. In addition, PMMA membranes are also known as cytokine‐adsorbing hemofilters and are effective in the treatment of severe sepsis 31 .…”

Case report: therapeutic monitoring of vancomycin in an acute liver failure patient with anuria under high-flow continuous hemodiafiltration

“…To ensure efficacy and to avoid adverse effects of VCM, therapeutic drug monitoring is critically important [ 6 ]. Furthermore, since VCM is removed by hemodiafiltration [ 7 ], individual dosage design is essential [ 8 – 10 ].…”

Catalysis of electro-oxidation of antibiotics by nitroxyl radicals and the electrochemical sensing of vancomycin

“…, HPLC, GC). 5,6 Immunological methods, such as enzyme immunoassays (HEIA, EMIT), fluorescence immunoassays (FPIA), 7,8 chemiluminescence immunoassays (CLIA), 9 and latex agglutination turbidimetry (KIMS, 10 PETINIA 11 ) are simple and rapid assays. However, antibodies are affected differently by metabolites and concomitant drugs, resulting in different assay values.…”