Hansen E, Bucher M, Jakob W, Lemberger P, Kees F
Intensive Care Unit, Clinic of Anesthesiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany.
Intensive Care Med. 2001 Feb;27(2):371-5. doi: 10.1007/s001340000836.
To study the effect of continuous veno-venous hemofiltration (CVVHF) on the pharmacokinetics of levofloxacin in critically ill patients with acute renal failure.
Open-label study.
Anesthesiology ICU, University Hospital of Regensburg.
Six critically ill patients treated with CVVHF because of acute renal failure needing antimicrobial therapy.
Levofloxacin i.v. 250 mg qd with a starting dose of 500 mg. CVVHF with the following characteristics: hemofilter AN69 hollow fibers of 0.90 m2 area, blood flow 150 ml/min, ultrafiltrate flow 1.3 l/h, filtrate substitution in post-dilution mode.
The plasma pharmacokinetics and clearance of levofloxacin by hemofiltration were established on day 1 and day 4-6 of treatment. Levofloxacin was determined by high-performance liquid chromatography (HPLC). Mean (range) peak plasma concentrations after levofloxacin 500 mg single dose (s.d.) and 250 mg multiple dose (m.d.) were 6.4 (2.7-9.4) and 8.2 (4.7-10.3) mg/l, trough levels 2.7 (1.4-5.0) and 2.9 (1.7-3.9) mg/l, half-life 28 (19-38) and 22 (17-31) h, volume of distribution 1.2 (0.72-1.6) l/kg and 0.91 (0.52-2.0) l/kg, respectively. The mean sieving coefficient was 0.96 (0.79-1.09), mean total clearance 47 (20-89) ml/min, and mean clearance by hemofiltration 21 (13-27) ml/min, respectively.
A dosage schedule of levofloxacin 250 mg qd with a 500 mg loading dose seems appropriate for anuric patients during CVVHF. Sufficiently high steady-state concentrations of levofloxacin were achieved after the first dose. Undesired accumulation of levofloxacin was not observed.
研究持续静静脉血液滤过（CVVHF）对急性肾衰竭危重症患者左氧氟沙星药代动力学的影响。
开放标签研究。
雷根斯堡大学医院麻醉重症监护病房。
6例因急性肾衰竭需要抗菌治疗而接受CVVHF治疗的危重症患者。
静脉注射左氧氟沙星，剂量为250mg每日一次，起始剂量为500mg。CVVHF具有以下特点：血液滤过器为面积0.90平方米的AN69中空纤维，血流量150ml/分钟，超滤流速1.3升/小时，后稀释模式下的滤液置换。
在治疗第1天和第4 - 6天确定左氧氟沙星的血浆药代动力学及血液滤过清除率。采用高效液相色谱法（HPLC）测定左氧氟沙星。单次剂量500mg（s.d.）和多次剂量250mg（m.d.）左氧氟沙星后的平均（范围）血浆峰浓度分别为6.4（2.7 - 9.4）mg/l和8.2（4.7 - 10.3）mg/l，谷浓度分别为2.7（1.4 - 5.0）mg/l和2.9（1.7 - 3.9）mg/l，半衰期分别为28（19 - 38）小时和22（17 - 31）小时，分布容积分别为1.2（0.72 - 1.6）升/千克和0.91（0.52 - 2.0）升/千克。平均筛系数为0.96（0.79 - 1.09），平均总清除率为47（20 - 89）ml/分钟，平均血液滤过清除率为21（13 - 27）ml/分钟。
对于CVVHF期间的无尿患者，左氧氟沙星剂量方案为每日一次250mg，负荷剂量500mg似乎合适。首剂后可达到足够高的左氧氟沙星稳态浓度。未观察到左氧氟沙星的不良蓄积。
