Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland.
Clinical Department of Anaesthesiology and Intensive Care, Regional Specialist Hospital in Olsztyn, Poland.
Anaesthesiol Intensive Ther. 2020;52(4):267-273. doi: 10.5114/ait.2020.99605.
The first studies on the pharmacokinetics of ciprofloxacin during continuous renal replacement therapy were conducted using filters with a relatively small surface area and with lower intensity of the procedure than nowadays. The aim of this study was to assess the pharmacokinetics and the probability of achieving pharmacokinetic/pharmacodynamic (PK/PD) target for ciprofloxacin during renal replacement therapy using a filter with large surface area and higher intensity.
Eighteen patients were considered eligible for treatment with ciprofloxacin (400 mg every eight hours intravenously) during continuous renal replacement therapy. Blood samples were collected from the arterial line of the renal replacement circuit before (time 0) and after 30, 60, 75, 90, 120, 180, 240, and 480 minutes following the initiation of ciprofloxacin infusion. Ciprofloxacin concentrations in the collected samples were determined using fully validated liquid chromatography. The pharmacokinetic analysis was performed using non-compartmental analysis. The measure adopted to assess the efficacy of the antibiotic therapy was the proportion of patients for whom pre-defined PK/PD indices were achieved.
There was a considerable inter-individual variability observed in pharmacokinetic parameters for ciprofloxacin. 100% of patients achieved PK/PD target AUC0-24/MIC > 40, AUC0-24/MIC > 125, AUC0-24/MIC > 250 for MIC 1, 0.25, and 0.125 µg mL-1, respectively.
High doses of ciprofloxacin (400 mg every eight hours intravenously) during continuous renal replacement therapy should be used to maximally increase the proportion of patients in whom clinical efficacy, expressed as achieving the PK/PD target, is reached.
首次在连续肾脏替代治疗中研究环丙沙星的药代动力学是使用表面积相对较小且治疗强度较低的过滤器进行的，这与现在的情况不同。本研究旨在评估使用表面积较大且治疗强度较高的过滤器进行连续肾脏替代治疗时环丙沙星的药代动力学和达到药代动力学/药效学（PK/PD）目标的可能性。
18 名患者被认为有资格在连续肾脏替代治疗期间接受环丙沙星（400mg 每 8 小时静脉内）治疗。在开始输注环丙沙星后 30、60、75、90、120、180、240 和 480 分钟，从肾脏替代回路的动脉线上采集血样。使用完全验证的液相色谱法测定采集样本中环丙沙星的浓度。使用非房室分析进行药代动力学分析。评估抗生素治疗效果的措施是达到预定义 PK/PD 指数的患者比例。
观察到环丙沙星的药代动力学参数存在相当大的个体间变异性。100%的患者达到了 PK/PD 目标 AUC0-24/MIC > 40、AUC0-24/MIC > 125、AUC0-24/MIC > 250，分别为 MIC 1、0.25 和 0.125µg mL-1。
在连续肾脏替代治疗中应使用高剂量（400mg 每 8 小时静脉内）的环丙沙星，以最大限度地增加达到 PK/PD 目标的临床疗效的患者比例。
