1
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Sharrock L, Ankravs MJ, Deane AM, Rechnitzer T, Wallis SC, Roberts JA, Bellomo R. Clearance of Piperacillin-Tazobactam and Vancomycin During Continuous Renal Replacement With Regional Citrate Anticoagulation. Ther Drug Monit 2023; 45:265-268. [PMID: 35994070 DOI: 10.1097/ftd.0000000000001028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/19/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The use of regional citrate anticoagulation during continuous venovenous hemodiafiltration (CVVHDF) has increased worldwide. However, data on its effect on the pharmacokinetics of antibiotics are limited. In this study, the authors aimed to measure the clearance of piperacillin-tazobactam and vancomycin in patients receiving CVVHDF with regional citrate anticoagulation. METHODS This study measured piperacillin-tazobactam and vancomycin concentrations in patients receiving CVVHDF with regional citrate anticoagulation. Dosing regimens were independently selected by intensivists. Arterial blood and effluent fluid samples were obtained over a single dosing interval and analyzed using ultra-high-performance liquid chromatography with tandem mass spectrometry. RESULTS Seventeen sampling intervals in 15 patients (9 receiving piperacillin-tazobactam only, 4 receiving vancomycin only, and 2 receiving both) were used. The median overall clearance for piperacillin was 35.2 mL/min [interquartile range (IQR): 32.2-38.6], 70 mL/min (IQR: 62.7-76.2) for tazobactam, and 29.5 mL/min (IQR: 26.2-32) for vancomycin. CONCLUSIONS This is the first study to quantify the pharmacokinetics of vancomycin and piperacillin-tazobactam in patients receiving CVVHDF with regional citrate anticoagulation. These results indicate high clearance and provide key information to guide optimal dosing.
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Affiliation(s)
- Lucy Sharrock
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Pharmacy Department, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Melissa J Ankravs
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Pharmacy Department, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Critical Care, Melbourne Medical School, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Adam M Deane
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Critical Care, Melbourne Medical School, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Thomas Rechnitzer
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Steven C Wallis
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Jason A Roberts
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Division of Anaesthesiology, Critical Care, Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Rinaldo Bellomo
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Critical Care, Melbourne Medical School, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia; and
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
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2
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Wenzler E, Butler D, Tan X, Katsube T, Wajima T. Pharmacokinetics, Pharmacodynamics, and Dose Optimization of Cefiderocol during Continuous Renal Replacement Therapy. Clin Pharmacokinet 2022; 61:539-552. [PMID: 34792787 PMCID: PMC9167810 DOI: 10.1007/s40262-021-01086-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The need for continuous renal replacement therapy (CRRT) in critically ill patients with serious infections is associated with clinical failure, emergence of resistance, and excess mortality. These poor outcomes are attributable in large part to subtherapeutic antimicrobial exposure and failure to achieve target pharmacokinetic/pharmacodynamic (PK/PD) thresholds during CRRT. Cefiderocol is a novel siderophore cephalosporin with broad in vitro activity against resistant pathogens and is often used to treat critically ill patients, including those receiving CRRT, despite the lack of data to guide dosing in this population. OBJECTIVE The aim of this study was to evaluate the PK and PD of cefiderocol during in vitro and in vivo CRRT and provide optimal dosing recommendations. METHODS The PK and dialytic clearance of cefiderocol was evaluated via an established in vitro CRRT model across various modes, filter types, and effluent flow rates. These data were combined with in vivo PK data from nine patients receiving cefiderocol while receiving CRRT from phase III clinical trials. Optimal dosing regimens and their respective probability of target attainment (PTA) were assessed via an established population PK model with Bayesian estimation and 1000-subject Monte Carlo simulations at each effluent flow rate. RESULTS The overall mean sieving/saturation coefficient during in vitro CRRT was 0.90 across all modes, filter types, effluent flow rates, and points of replacement fluid dilution tested. Adsorption was negligible at 10.9%. Three-way analysis of variance (ANOVA) and multiple linear regression analyses demonstrated that effluent flow rate is the primary driver of clearance during CRRT and can be used to calculate optimal cefiderocol doses required to match the systemic exposure observed in patients with normal renal function. Bayesian estimation of these effluent flow rate-based optimal doses in nine patients receiving CRRT from the phase III clinical trials of cefiderocol revealed comparable mean (± standard deviation) area under the concentration-time curve values as patients with normal renal function (1709 ± 539 mg·h/L vs. 1494 ± 58.4 mg·h/L; p = 0.26). Monte Carlo simulations confirmed these doses achieved >90% PTA against minimum inhibitory concentrations ≤4 mg/L at effluent flow rates from 0.5 to 5 L/h. CONCLUSION The optimal dosing regimens developed from this work have been incorporated into the prescribing information for cefiderocol, making it the first and only antimicrobial with labeled dosing for CRRT. Future clinical studies are warranted to confirm the efficacy and safety of these regimens.
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Affiliation(s)
- Eric Wenzler
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street, Room 164 (M/C 886), Chicago, IL, 60612, USA.
| | - David Butler
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street, Room 164 (M/C 886), Chicago, IL, 60612, USA
| | - Xing Tan
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street, Room 164 (M/C 886), Chicago, IL, 60612, USA
| | - Takayuki Katsube
- Clinical Pharmacology and Pharmacokinetics, Shionogi & Co., Ltd., Osaka, Japan
| | - Toshihiro Wajima
- Clinical Pharmacology and Pharmacokinetics, Shionogi & Co., Ltd., Osaka, Japan
- Clinical Pharmacology, IDEC Inc., Nishi-Shinjuku 6-5-1, Shinjuku-ku, Tokyo, 163-1341, Japan
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3
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Shudofsky KN, Janssen PKC, Foudraine N, le Noble JLML. Clearance of Lormetazepam, Midazolam, and Their Conjugated Metabolites by Continuous Venovenous Hemofiltration During Prolonged Sedation in Critically Ill Patients With COVID-19-Associated Acute Respiratory Distress Syndrome. J Clin Pharmacol 2021; 62:568-570. [PMID: 34793610 PMCID: PMC9477438 DOI: 10.1002/jcph.2005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/13/2021] [Indexed: 11/26/2022]
Affiliation(s)
| | - Paddy K C Janssen
- Department of Clinical Pharmacy, VieCuri Medical Center, Venlo, The Netherlands.,Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Norbert Foudraine
- Department of Intensive Care, VieCuri Medical Center, Venlo, The Netherlands
| | - Jos L M L le Noble
- Department of Intensive Care, VieCuri Medical Center, Venlo, The Netherlands.,Department of Pharmacology and Toxicology, UM, Maastricht, The Netherlands
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4
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Andrews L, Benken S, Tan X, Wenzler E. Pharmacokinetics and dialytic clearance of apixaban during in vitro continuous renal replacement therapy. BMC Nephrol 2021; 22:45. [PMID: 33516188 PMCID: PMC7847018 DOI: 10.1186/s12882-021-02248-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/19/2021] [Indexed: 12/26/2022] Open
Abstract
Background To evaluate the transmembrane clearance (CLTM) of apixaban during modeled in vitro continuous renal replacement therapy (CRRT), assess protein binding and circuit adsorption, and provide initial dosing recommendations. Methods Apixaban was added to the CRRT circuit and serial pre-filter bovine blood samples were collected along with post-filter blood and effluent samples. All experiments were performed in duplicate using continuous veno-venous hemofiltration (CVVH) and hemodialysis (CVVHD) modes, with varying filter types, flow rates, and point of CVVH replacement fluid dilution. Concentrations of apixaban and urea were quantified via liquid chromatography-tandem mass spectrometry. Plasma pharmacokinetic parameters for apixaban were estimated via noncompartmental analysis. CLTM was calculated via the estimated area under the curve (AUC) and by the product of the sieving/saturation coefficient (SC/SA) and flow rate. Two and three-way analysis of variance (ANOVA) models were built to assess the effects of mode, filter type, flow rate, and point of dilution on CLTM by each method. Optimal doses were suggested by matching the AUC observed in vitro to the systemic exposure demonstrated in Phase 2/3 studies of apixaban. Linear regression was utilized to provide dosing estimations for flow rates from 0.5–5 L/h. Results Mean adsorption to the HF1400 and M150 filters differed significantly at 38 and 13%, respectively, while mean (± standard deviation, SD) percent protein binding was 70.81 ± 0.01%. Effect of CVVH point of dilution did not differ across filter types, although CLTM was consistently significantly higher during CRRT with the HF1400 filter compared to the M150. The three-way ANOVA demonstrated improved fit when CLTM values calculated by AUC were used (adjusted R2 0.87 vs. 0.52), and therefore, these values were used to generate optimal dosing recommendations. Linear regression revealed significant effects of filter type and flow rate on CLTM by AUC, suggesting doses of 2.5–7.5 mg twice daily (BID) may be needed for flow rates ranging from 0.5–5 L/h, respectively. Conclusion For CRRT flow rates most commonly employed in clinical practice, the standard labeled 5 mg BID dose of apixaban is predicted to achieve target systemic exposure thresholds. The safety and efficacy of these proposed dosing regimens warrants further investigation in clinical studies. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02248-7.
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Affiliation(s)
- Lauren Andrews
- College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street, Room 164 (M/C 886),, Chicago, IL, 60612, USA
| | - Scott Benken
- College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street, Room 164 (M/C 886),, Chicago, IL, 60612, USA
| | - Xing Tan
- College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street, Room 164 (M/C 886),, Chicago, IL, 60612, USA
| | - Eric Wenzler
- College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street, Room 164 (M/C 886),, Chicago, IL, 60612, USA.
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5
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Thønnings S, Jensen KS, Nielsen NB, Skjønnemand M, Hansen DS, Lange KHW, Frimodt-Møller N. Cefuroxime pharmacokinetics and pharmacodynamics for intravenous dosage regimens with 750 mg or 1500 mg doses in healthy young volunteers. J Med Microbiol 2020; 69:387-395. [DOI: 10.1099/jmm.0.001138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Cefuroxime is an important antibiotic to treat several serious infections. Rapid elimination through the kidneys and the variation in MICs of various susceptible pathogens such as Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus and
Streptococcus pneumoniae
give rise to dosing issues, especially in otherwise healthy patients.
Aim. To investigate the probability of target attainment (PTA) for obtaining the optimal dosage regimens for cefuroxime in healthy young people.
Methodology. Two weeks apart 750 and 1500 mg cefuroxime were administered as an intravenous bolus to 20 healthy volunteers (mean age: 27 years). Population modelling and simulation studies were done based on the obtained data for cefuroxime plasma concentration.
Results. With a target value of time above MIC (T
>MIC) greater than 50 % the simulations revealed that a PTA of >99 % is obtained for
S. pneumoniae
with a dosage regimen of 750 mg q12h. For
E. coli
and
K. pneumoniae
the PTA was <90 % even with the highest, simulated dosage of 1500 mg q6h. For
S. aureus
a dosage of 1500 mg q8h gave a PTA above 97 %.
Conclusions.
S. pneumoniae
is most likely treatable with a two-daily dose of 750 mg cefuroxime. Not treatable are
K. pneumoniae
and
E. coli
. For
S. aureus
1500 mg q8h constitutes an optimal dosing schedule.
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Affiliation(s)
- Sara Thønnings
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Ninna B. Nielsen
- Department of Anesthesiology and Intensive Care, Nordsjællands hospital, Hillerød, Denmark
| | - Martin Skjønnemand
- Department of Anesthesiology and Intensive Care, Nordsjællands hospital, Hillerød, Denmark
| | | | - Kai H. W. Lange
- Department of Anesthesiology and Intensive Care, Nordsjællands hospital, Hillerød, Denmark
| | - Niels Frimodt-Møller
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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6
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le Noble JLML, Meenks SD, Foudraine N, Janssen PKC. Alterations in transmembrane pressures during continuous venovenous haemofiltration significantly contribute to the pharmacokinetic variability of meropenem: a case series of three patients. J Antimicrob Chemother 2020; 74:271-273. [PMID: 30295774 DOI: 10.1093/jac/dky411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jos L M L le Noble
- Department of Intensive Care, VieCuri Medical Center, Venlo, BX Venlo, The Netherlands
- Department of Pharmacology and Toxicology, Maastricht University, MD Maastricht, The Netherlands
| | - Sjoerd D Meenks
- Department of Hospital Pharmacy, VieCuri Medical Center Venlo, BX Venlo, The Netherlands
| | - Norbert Foudraine
- Department of Intensive Care, VieCuri Medical Center, Venlo, BX Venlo, The Netherlands
| | - Paddy K C Janssen
- Department of Hospital Pharmacy, VieCuri Medical Center Venlo, BX Venlo, The Netherlands
- CAPHRI: School for Public Health and Primary Care, Maastricht University, MD Maastricht, The Netherlands
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7
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van Raaij JJ, Mabelis NJD, Shudofsky KN, Meenks SD, le Noble JLML, Janssen PKC. Quantification of total and unbound cefuroxime in plasma by ultra-performance liquid chromatography tandem mass spectrometry in a cohort of critically ill patients with hypoalbuminemia and renal failure. J Clin Lab Anal 2019; 34:e23100. [PMID: 31785116 PMCID: PMC7083463 DOI: 10.1002/jcla.23100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/25/2019] [Accepted: 10/08/2019] [Indexed: 12/03/2022] Open
Abstract
Background Pharmacokinetic studies of cefuroxime by ultra‐performance liquid chromatography tandem mass spectrometry (UPLC‐MS/MS) have been limited to measurements of total concentrations. Here, we developed a robust method for quantifying total and unbound cefuroxime concentrations using UPLC‐MS/MS and ultrafiltration in critically ill patients with hypoalbuminemia and renal failure. Methods Method validation included accuracy, linearity, precision, repeatability, recovery, and limit of quantification (LOQ). Feasibility of the method was performed on samples obtained from randomly selected intensive care unit (ICU) patients. Total and unbound cefuroxime concentrations were quantified using UPLC‐MS/MS. Sampling times were categorized as trough (180‐1 min prior to administration), peak (10‐30 min after administration), mid (30‐360 min after administration), and continuous (sampling during administration). Pharmacokinetic/pharmacodynamic (PK/PD) targets were unbound cefuroxime concentrations above 4 times the minimum inhibitory concentration (32 mg/L). Results Intra‐assay and inter‐assay precision was <3%. Recovery was 99.7%‐100.3%, and LOQ was 0.1 mg/L. We included 11 patients (median age 72 years (range 54‐77). Median albumin serum concentrations and eGFR were 19 g/L (range 11‐40 g/L) and 48 mL/min/1.73 m2 (range 7‐115 mL/min/1.73 m2), respectively. Median trough and mid concentrations of total cefuroxime were 22.27 mg/L (range 5.42‐54.03 mg/L) and 71.49 mg/L (range 53.87‐73.86 mg/L), and median unbound fraction was 75.42% (range 27.36%‐99.75%). Median unbound cefuroxime concentrations were 11.94 mg/L (range 3.85‐32.39 mg/L) (trough) and 55.62 mg/L (range 10.03‐62.62 mg/L) (mid). Conclusion The method is precise and accurate according to ISO 15189 and within the clinical range of cefuroxime (0.5‐100 mg/L). The method was applied in ICU patients and is suitable for TDM on unbound cefuroxime concentrations.
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Affiliation(s)
- Joost J van Raaij
- Department of Hospital Pharmacy, VieCuri Medical Centre, Venlo, The Netherlands
| | - Noortje J D Mabelis
- Department of Hospital Pharmacy, VieCuri Medical Centre, Venlo, The Netherlands
| | | | - Sjoerd D Meenks
- Department of Hospital Pharmacy, VieCuri Medical Centre, Venlo, The Netherlands
| | - Jos L M L le Noble
- Department of Intensive Care, VieCuri Medical Centre, Venlo, The Netherlands.,Department of Pharmacology and Toxicology, Maastricht University, The Netherlands
| | - Paddy K C Janssen
- Department of Hospital Pharmacy, VieCuri Medical Centre, Venlo, The Netherlands.,Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
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8
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Ebisch RMF, Meenks SD, Foudraine N, Janssen PKC, le Noble JLML. Ceftriaxone Dosing in a Critically Ill Patient With Hypoalbuminemia During Continuous Venous Hemofiltration: Emphasis on Unbound Pharmacokinetics. J Clin Pharmacol 2019; 60:140-142. [PMID: 31407809 DOI: 10.1002/jcph.1503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 07/16/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Renée M F Ebisch
- Department of Intensive Care, VieCuri Medical Center Venlo, Venlo, the Netherlands
| | - Sjoerd D Meenks
- Department of Hospital Pharmacy, VieCuri Medical Center Venlo, Venlo, the Netherlands.,Department of Clinical Pharmacy and Toxicology, CAPHRI School of Public Health and Primary Care, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Norbert Foudraine
- Department of Intensive Care, VieCuri Medical Center Venlo, Venlo, the Netherlands
| | - Paddy K C Janssen
- Department of Hospital Pharmacy, VieCuri Medical Center Venlo, Venlo, the Netherlands.,Department of Clinical Pharmacy and Toxicology, CAPHRI School of Public Health and Primary Care, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jos L M L le Noble
- Department of Intensive Care, VieCuri Medical Center Venlo, Venlo, the Netherlands.,Department of Pharmacology and Toxicology, Maastricht University, Maastricht, the Netherlands
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9
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Population Pharmacokinetic Model-Based Evaluation of Standard Dosing Regimens for Cefuroxime Used in Coronary Artery Bypass Graft Surgery with Cardiopulmonary Bypass. Antimicrob Agents Chemother 2018; 62:AAC.02241-17. [PMID: 29358296 DOI: 10.1128/aac.02241-17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/09/2018] [Indexed: 11/20/2022] Open
Abstract
The purpose of this study was to investigate the population pharmacokinetics (PK) of cefuroxime in patients undergoing coronary artery bypass graft (CABG) surgery. In this observational pharmacokinetic study, multiple blood samples were collected over a 48-h interval of intravenous cefuroxime administration. The samples were analyzed by using a validated high-performance liquid chromatography (HPLC) method. Population pharmacokinetic models were developed using Monolix (version 4.4) software. Pharmacokinetic-pharmacodynamic (PD) simulations were performed to explore the ability of different dosage regimens to achieve the pharmacodynamic targets. A total of 468 blood samples from 78 patients were analyzed. The PK for cefuroxime were best described by a two-compartment model with between-subject variability on clearance, the volume of distribution of the central compartment, and the volume of distribution of the peripheral compartment. The clearance of cefuroxime was related to creatinine clearance (CLCR). Dosing simulations showed that standard dosing regimens of 1.5 g could achieve the PK-PD target of the percentage of the time that the free concentration is maintained above the MIC during a dosing interval (fTMIC) of 65% for an MIC of 8 mg/liter in patients with a CLCR of 30, 60, or 90 ml/min, whereas this dosing regimen failed to achieve the PK-PD target in patients with a CLCR of ≥125 ml/min. In conclusion, administration of standard doses of 1.5 g three times daily provided adequate antibiotic prophylaxis in patients undergoing CABG surgery. Lower doses failed to achieve the PK-PD target. Patients with high CLCR values required either higher doses or shorter intervals of cefuroxime dosing. On the other hand, lower doses (1 g three times daily) produced adequate target attainment for patients with low CLCR values (≤30 ml/min).
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