In:
Kidney and Blood Pressure Research, S. Karger AG, Vol. 26, No. 2 ( 2003), p. 135-140
Abstract:
〈 i 〉 Background: 〈 /i 〉 Flucloxacillin is an important antimicrobial drug in the treatment of infections with 〈 i 〉 Staphylococcus aureus 〈 /i 〉 and therefore is often used in staphylococcal infections. Furthermore, flucloxacillin has a high protein binding rate as for example ceftriaxone or teicoplanin – drugs which have formerly been characterized as not being dialyzable. 〈 i 〉 Methods: 〈 /i 〉 The pharmacokinetic parameters of 4.0 g flucloxacillin every 8 h were examined in 10 intensive care patients during continuous venovenous hemofiltration (CVVH) using a polyamide capillary hemofilter. In addition, the difficulty of calculating the hemofiltration clearance of a highly protein-bound drug is described. 〈 i 〉 Results: 〈 /i 〉 Flucloxacillin serum levels were significantly lowered (56.9 ± 24.0%) even though only 15% of the drug was detected in the ultrafiltrate. Elimination half-life, total body clearance and sieving coefficient were 4.9 ± 0.7 h, 117.2 ± 79.1 ml/min and 0.21 ± 0.09, respectively. These discrepancies can be explained by the high protein binding of flucloxacillin, the adsorbing property of polyamide and the equation in order to calculate hemofiltration clearance. The unbound fraction of a 4.0 g flucloxacillin dosage facilitates time above the minimum inhibitory concentration (T 〉 MIC) of 60% only for strains up to a minimum inhibitory concentration (MIC) of 0.5 mg/l. 〈 i 〉 Conclusion: 〈 /i 〉 Based on the data of this study, we conclude that intensive care patients with staphylococcal infections on CVVH should be treated with 4.0 g flucloxacillin every 8 h which was safe and well tolerated. Moreover, further studies with highly protein-bound drugs are recommended to check the classical ‘hemodialysis’ equation as the standard equation in calculating the CVVH clearance of highly protein-bound drugs.
Type of Medium:
Online Resource
ISSN:
1420-4096
,
1423-0143
Language:
English
Publisher:
S. Karger AG
Publication Date:
2003
detail.hit.zdb_id:
1482922-8
