Mauro Laurie S, Peloquin Charles A, Schmude Kimberly, Assaly Ragheb, Malhotra Deepak
University of Toledo College of Pharmacy, OH, USA.
Am J Kidney Dis. 2006 Jun;47(6):e83-6. doi: 10.1053/j.ajkd.2006.03.037.
Linezolid is being used increasingly for life-threatening vancomycin-resistant infections in critically ill patients. Limited data suggest that linezolid is cleared by intermittent hemodialysis. However, information on clearance of linezolid by continuous renal replacement therapy is limited. A patient undergoing continuous venovenous hemodiafiltration (CVVHDF) was evaluated to determine linezolid clearance through CVVHDF.
A 33-year-old man with necrotizing fasciitis and acute-on-chronic renal failure requiring CVVHDF was treated with linezolid, 600 mg every 12 hours, for a vancomycin-resistant urinary tract infection. The study was performed on day 4 of therapy after a 1-hour infusion of linezolid. A series of blood samples and all urine and diafiltrate were collected during a 12-hour period. Linezolid concentrations were determined by using high-performance liquid chromatography assay. Linezolid clearance through CVVHDF was determined by using 2 methods. Method 1 evaluated the amount of drug recovered in diafiltrate. Method 2 evaluated plasma drug concentrations in prefilter and postfilter (PAN-10 Hemofilter; Asahi Medical Co, Tokyo, Japan) samples.
Clearance of linezolid through CVVHDF was 15.6 mL/min by method 1 and 21.6 mL/min by method 2. Total-body clearance was 189 mL/min. The amount of linezolid recovered in diafiltrate was 50 mg (8.3% of the dose).
Clearance of linezolid through CVVHDF in this patient was marginal. It does not appear that supplemental dosing of linezolid is necessary in patients undergoing CVVHDF.
利奈唑胺越来越多地用于治疗重症患者危及生命的耐万古霉素感染。有限的数据表明利奈唑胺可通过间歇性血液透析清除。然而，关于利奈唑胺通过连续性肾脏替代治疗清除的信息有限。对一名接受连续性静脉-静脉血液透析滤过（CVVHDF）的患者进行评估，以确定利奈唑胺通过CVVHDF的清除情况。
一名33岁患有坏死性筋膜炎和慢性肾功能衰竭急性加重且需要CVVHDF的男性，因耐万古霉素的尿路感染接受利奈唑胺治疗，每12小时600mg。该研究在利奈唑胺输注1小时后的治疗第4天进行。在12小时内收集一系列血样以及所有尿液和透析液。使用高效液相色谱法测定利奈唑胺浓度。通过两种方法确定利奈唑胺通过CVVHDF的清除率。方法1评估透析液中回收的药物量。方法2评估滤器前和滤器后（PAN - 10血液滤过器；日本东京旭化成医疗株式会社）样本中的血浆药物浓度。
方法1测得利奈唑胺通过CVVHDF的清除率为15.6 mL/分钟，方法2为21.6 mL/分钟。全身清除率为189 mL/分钟。透析液中回收的利奈唑胺量为50mg（占剂量的8.3%）。
该患者中利奈唑胺通过CVVHDF的清除率较低。对于接受CVVHDF的患者，似乎无需补充利奈唑胺剂量。
