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Variable Disposition of Ciprofloxacin in Critically Ill Patients Undergoing Continuous Arteriovenous Hemodiafiltration
Author(s) -
Fish Douglas N.,
Bainbridge Jacquelyn L.,
Peloquin Charles A.
Publication year - 1995
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/j.1875-9114.1995.tb04359.x
Subject(s) - ciprofloxacin , dosing , medicine , pharmacokinetics , extracorporeal , critically ill , intensive care medicine , drug , therapeutic drug monitoring , pharmacology , antibiotics , microbiology and biotechnology , biology
Continuous arteriovenous hemodiafiltration (CAVHD) is being used increasingly in critically ill patients with acute renal failure (ARF). We prospectively evaluated extracorporeal and total systemic clearances (Cl CAVHD and Cl s ) of ciprofloxacin during CAVHD in four patients with severe ARF to assess the adequacy of drug dosing. Ciprofloxacin serum and ultrafiltrate concentrations were measured by high‐performance liquid chromatography. The Cl CAVHD accounted for approximately 5.9% (range 2.8–11.6%) of Cl s of ciprofloxacin. However, large variability in serum concentrations was observed with the normally recommended dose of 400 mg/day, and doses of up to 800 mg/day were required to maintain concentrations suitable for treatment of serious infections. High daily doses of ciprofloxacin required in these patients are likely related to altered pharmacokinetics in serious illness as well as to the increased extracorporeal clearance during CAVHD. Clinical studies to define appropriate dosing recommendations for ciprofloxacin during CAVHD are necessary to guide clinicians in optimum drug use.