Elimination of vancomycin by continuous arteriovenous hemofiltration.

Continuous arteriovenous hemofiltration (CAVH) is being used increasingly in pediatric patients with acute renal failure and/or other fluid and electrolyte imbalances. At times, vancomycin may be concurrently given for sepsis therapy. We evaluated the removal of vancomycin by CAVH in a 15-month-old male child with renal failure who was receiving the drug for suspected infection of an arterial catheter. Two separate CAVH treatments were performed with polysulfone membranes. Serum samples and ultrafiltrate outflow (n = 6) were collected over 79 h for vancomycin concentration determination. The mean vancomycin concentration in the ultrafiltrate was 90.4 +/- 5.4% of those of the serum. 0.53-1.11 mg of the drug was removed per hour by CAVH at serum concentrations of 12.4-25.4 mg/l. CAVH vancomycin clearance was 0.039-0.050 liter/h. The CAVH drug clearances accounted for 66.2% of the total vancomycin clearance. CAVH is thus a major route of vancomycin elimination. Dosage adjustment and serum concentration monitoring are necessary in patients undergoing CAVH while receiving vancomycin therapy.