Division of Clinical Pharmacology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
Department of Pharmacology and Toxicology, University of Utah, Salt Lake City, UT, USA.
J Infect Chemother. 2023 Dec;29(12):1119-1125. doi: 10.1016/j.jiac.2023.08.007. Epub 2023 Aug 10.
Ceftazidime and clindamycin are commonly prescribed to critically ill patients who require extracorporeal life support such as ECMO and CRRT. The effect of ECMO and CRRT on the disposition of ceftazidime and clindamycin is currently unknown.
Ceftazidime and clindamycin extraction were studied with ex vivo ECMO and CRRT circuits primed with human blood. The percent recovery of these drugs over time was calculated to determine the degree of interaction between these drugs and circuit components.
Neither ceftazidime nor clindamycin exhibited measurable interactions with the ECMO circuit. In contrast, CRRT cleared 100% of ceftazidime from the experimental circuit within the first 2 h. Clearance of clindamycin from the CRRT circuit was slower, with about 20% removed after 6 h.
Clindamycin and ceftazidime dosing adjustments are likely required in patients who are supported with CRRT, and future studies to quantify these adjustments should consider the pathophysiology of the patient in combination with the clearance due to CRRT. Dosing adjustments to account for adsorption to ECMO circuit components are likely unnecessary and should focus instead on the pathophysiology of the patient and changes in volume of distribution. These results will help improve the safety and efficacy of ceftazidime and clindamycin in patients requiring ECMO and CRRT.
头孢他啶和克林霉素常用于需要体外生命支持（如 ECMO 和 CRRT）的重症患者。目前尚不清楚 ECMO 和 CRRT 对头孢他啶和克林霉素处置的影响。
用含有人体血液的体外 ECMO 和 CRRT 回路进行头孢他啶和克林霉素的提取研究。随着时间的推移计算这些药物的回收率，以确定这些药物与回路组件之间的相互作用程度。
头孢他啶和克林霉素均未与 ECMO 回路发生可测量的相互作用。相比之下，CRRT 在最初的 2 小时内从实验回路中清除了 100%的头孢他啶。克林霉素从 CRRT 回路中的清除速度较慢，6 小时后清除约 20%。
接受 CRRT 支持的患者可能需要调整克林霉素和头孢他啶的剂量，未来量化这些调整的研究应将患者的病理生理学与 CRRT 清除率结合起来考虑。考虑到吸附到 ECMO 回路组件上的调整剂量可能是不必要的，应将重点放在患者的病理生理学和分布容积的变化上。这些结果将有助于提高需要 ECMO 和 CRRT 的患者使用头孢他啶和克林霉素的安全性和疗效。
