Comparative polymyxin B pharmacokinetics in critically ill patients with renal insufficiency and in continuous veno-venous hemodialysis.
Purpose: The aim of this study was to assess polymyxin B pharmacokinetics (PK) in patients with varying degrees of renal dysfunction and in patients who require continuous veno-venous hemodialysis (CVVHD). Methods: The study enrolled 37 patients with sepsis, including 13 patients with glomerular fil...
| Publicado en: | European Journal of Clinical Pharmacology Vol. 79; no. 1; pp. 79 - 88 |
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| Autores principales: | , , , , , |
| Formato: | equations & formulas research tables/charts Journal Article |
| Publicado: |
Springer Nature
Jan2023
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=161159752&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 161159752 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00316970 NP9 jtl: European Journal of Clinical Pharmacology issn: 00316970 maglogo: N pubinfo: dt: Jan2023 vid: 79 iid: 1 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 161159752 161159752 161159752 10.1007/s00228-022-03415-x 161159752 ppf: 79 ppct: 9 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Comparative polymyxin B pharmacokinetics in critically ill patients with renal insufficiency and in continuous veno-venous hemodialysis. aug: au: Surovoy, Yury A. Burkin, Maksim A. Galvidis, Inna A. Sobolev, Mikhail A. Rende, Onur Can Tsarenko, Sergei V. affil: I.I. Mechnikov Research Institute for Vaccines and Sera, 105064, Moscow, Russia sug: subj: Renal Insufficiency Drug Therapy Sepsis Drug Therapy Polymyxin B Pharmacokinetics Antibiotics Pharmacokinetics Continuous Venovenous Hemodialysis Methods Critically Ill Patients Psychosocial Factors Human Male Female Middle Age Aged Glomerular Filtration Rate Polymyxin B Blood Enzyme-Linked Immunosorbent Assay Descriptive Statistics Data Analysis Software T-Tests Mann-Whitney U Test Chi Square Test Middle Aged: 45-64 years Aged: 65+ years Male Female ab: Purpose: The aim of this study was to assess polymyxin B pharmacokinetics (PK) in patients with varying degrees of renal dysfunction and in patients who require continuous veno-venous hemodialysis (CVVHD). Methods: The study enrolled 37 patients with sepsis, including 13 patients with glomerular filtration rate (GFR) below 80 mL/min and 11 patients on CVVHD. Each patient received a loading dose of polymyxin B (200–300 mg) and at least 3 subsequent doses of 100–150 mg every 12 h. For every patient, 6–8 blood samples were collected between doses. Polymyxin B (PMB) serum concentration was determined using enzyme-linked immunosorbent assay. Results: In sepsis, patients with preserved renal function mean area under the curve over 24 h (AUC0–24 h) value reached 67.8 ± 9.8 mg*h/L, while in patients with GFR below 80 mL/min, mean AUC0–24 h was 87 ± 5.8 mg*h/L. PMB PK in patients with renal insufficiency was characterized by significantly lower clearance (CL) compared to the normal renal function group (2.1 ± 0.1 L/h vs 3.9 ± 0.4 L/h respectively). In patients on CVVHD, mean AUC0–24 h was 110.4 ± 10.3 mg*h/L, while CL reached 2 ± 0.23 L/h. The median recovery rate from dialysate constituted 22%. Simulation of different dosage regimens that indicate a fixed maintenance dose of 100 mg q12h with a loading dose of 200 mg is optimal for patients on CVVHD, and no dosage increase is required. Conclusion: This study demonstrates decreased clearance of PMB in patients with renal insufficiency, which puts them at risk of toxicity. Therefore, patients with extremes of renal function might benefit from therapeutic drug monitoring. For patients with anuria, who require CVVHD, we suggest a fixed dose of 100 mg q12h. pubtype: Academic Journal doctype: equations & formulas research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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