Czock David, Hüsig-Linde Cordula, Langhoff Anita, Schöpke Timo, Hafer Carsten, de Groot Kirsten, Swoboda Stefanie, Kuse Ernst, Haller Hermann, Fliser Danilo, Keller Frieder, Kielstein Jan T
Division of Nephrology, University Hospital Ulm, Ulm, Germany.
Clin J Am Soc Nephrol. 2006 Nov;1(6):1263-8. doi: 10.2215/CJN.01840506. Epub 2006 Sep 27.
Extended daily dialysis (EDD) is increasingly popular in the treatment of acute renal failure (ARF). EDD could remove drugs to a much different degree compared with intermittent standard hemodialysis or continuous renal replacement therapies; however, there are only scarce data on how EDD influences the pharmacokinetics of frequently used drugs. The aim of this study was to determine the pharmacokinetics of two quinolone antibiotics in patients who had anuric ARF and were being treated with EDD. Adult patients who were in the intensive care unit at a tertiary care university hospital and receiving moxifloxacin (n = 10) or levofloxacin (n = 5) therapy were included. The antibiotics were administered intravenously 8 h (400 mg of moxifloxacin) or 12 h (500 mg of levofloxacin) before EDD to study pharmacokinetics off and on EDD. Treatment lasted 8 h; blood and dialysate flow rates were 160 ml/min. In addition to standard pharmacokinetic parameters, the total dialysate concentration of both drugs was measured using a technically simple single-pass batch dialysis system for EDD. Moxifloxacin pharmacokinetics in critically ill patients who had ARF and were undergoing EDD were similar to those in healthy subjects without renal impairment. Levofloxacin, although removed by EDD, had a lower total clearance compared with healthy subjects. According to these findings, anuric critically ill patients who are undergoing EDD should be treated with the standard dosage of moxifloxacin (400 mg/d intravenously). The levofloxacin dosage, however, should be reduced according to the intensity of renal replacement therapy.
延长每日透析（EDD）在急性肾衰竭（ARF）治疗中越来越普遍。与间歇性标准血液透析或连续性肾脏替代治疗相比，EDD清除药物的程度有很大不同；然而，关于EDD如何影响常用药物的药代动力学的数据却很少。本研究的目的是确定在接受EDD治疗的无尿ARF患者中两种喹诺酮类抗生素的药代动力学。纳入了在一所三级大学医院重症监护病房接受莫西沙星（n = 10）或左氧氟沙星（n = 5）治疗的成年患者。在EDD前8小时（400mg莫西沙星）或12小时（500mg左氧氟沙星）静脉给予抗生素，以研究在EDD期间和非EDD期间的药代动力学。治疗持续8小时；血液和透析液流速为160ml/分钟。除了标准药代动力学参数外，还使用一种技术上简单的用于EDD的单通道批量透析系统测量了两种药物的总透析液浓度。患有ARF且正在接受EDD治疗的重症患者中莫西沙星的药代动力学与无肾功能损害的健康受试者相似。左氧氟沙星虽然可被EDD清除，但与健康受试者相比总清除率较低。根据这些发现，接受EDD治疗的无尿重症患者应以莫西沙星标准剂量（400mg/d静脉注射）治疗。然而，左氧氟沙星的剂量应根据肾脏替代治疗的强度进行调整。
