Chevalier Andrew, McKnite Autumn, Whelan Aviva, Imburgia Carina, Rower Joseph E, Watt Kevin M, Green Danielle J
Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
Department of Pharmacology and Toxicology, University of Utah, Salt Lake City, UT, USA.
Perfusion. 2024 Nov 5:2676591241297401. doi: 10.1177/02676591241297401.
Azithromycin and methylprednisolone are two medications that are commonly used in patients who require ECMO support. Unfortunately, ECMO support can decrease drug concentrations through adsorption to circuit components. Such interactions have not been well described for either azithromycin or methylprednisolone. This study determined the extraction of these medications by ECMO circuits in an system.
Medications were administered to closed-loop, blood-primed ECMO circuits to attain target therapeutic concentrations. Drug concentration remaining in the circuit was measured over 6 h. The difference in medication recovery was compared between the ECMO circuits and controls using two-sample t-tests.
Concentrations of azithromycin and methylprednisolone remained constant in control experiments over time, indicating medication stability in blood. There was no statistical difference in percent recovery after 6 h between control experiments and the ECMO circuits for either azithromycin ( = .32) or methylprednisolone ( = .17).
Azithromycin and methylprednisolone did not significantly interact with ECMO circuits. While these studies do not account for all pharmacokinetic changes that may occur as a result of ECMO and critical illness, they suggest that standard dosing may be adequate to achieve therapeutic concentrations of azithromycin and methylprednisolone.
阿奇霉素和甲泼尼龙是常用于需要体外膜肺氧合（ECMO）支持的患者的两种药物。不幸的是，ECMO支持可通过吸附到循环组件上而降低药物浓度。对于阿奇霉素或甲泼尼龙，此类相互作用尚未得到充分描述。本研究在一个系统中确定了ECMO回路对这些药物的提取情况。
将药物给予闭环、血液预充的ECMO回路以达到目标治疗浓度。在6小时内测量回路中剩余的药物浓度。使用双样本t检验比较ECMO回路和对照组之间药物回收率的差异。
在对照实验中，阿奇霉素和甲泼尼龙的浓度随时间保持恒定，表明药物在血液中的稳定性。对于阿奇霉素（P = 0.32）或甲泼尼龙（P = 0.17），对照实验和ECMO回路在6小时后的回收率百分比没有统计学差异。
阿奇霉素和甲泼尼龙与ECMO回路没有显著相互作用。虽然这些研究没有考虑到ECMO和危重病可能导致的所有药代动力学变化，但它们表明标准剂量可能足以达到阿奇霉素和甲泼尼龙的治疗浓度。
