Effect of cardiopulmonary bypass on vancomycin and netilmicin disposition.
The effect of cardiopulmonary bypass (CPB) on the disposition of vancomycin (15 mg/kg) and of netilmicin (3 mg/kg) was studied in 10 adults. The concentration-time profile of the drug in serum and renal clearance were characterized pre-CPB, during CPB, and post-CPB. Vancomycin and netilmicin exhibited initial decreases in mean concentrations in serum of 4.0 mg/liter (16.8%) and 2.2 mg/liter (29.1%), respectively, upon initiation of CPB. Netilmicin concentrations in serum rebounded to a mean of 0.6 mg/liter (15.4%) within 90 min on CPB and then continuously decreased. Vancomycin concentrations in serum demonstrated a rebound increase of 2.3 mg/liter (23.5%) at the end of CPB when the aorta was unclamped. Mean renal clearance throughout CPB was decreased for vancomycin (58.4 to 43.4 ml/min per m2) and netilmicin (53.4 to 31.5 ml/min per m2). The rebound in vancomycin concentration in serum strongly correlated with the length of time between unclamping the aorta and coming off CPB (r = 0.94), as well as with the increase in temperature upon rewarming (r = 0.92).
Klamerus
K J
KJ
College of Pharmacy, University of Illinois, Chicago 60612.
Rodvold
K A
KA
Silverman
N A
NA
Levitsky
S
S
D000328:Adult; D000368:Aged; D001831:Body Temperature; D002315:Cardiopulmonary Bypass; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D009428:Netilmicin / Q000493:pharmacokinetics*; D013997:Time Factors; D014640:Vancomycin / Q000493:pharmacokinetics*
D009428:Netilmicin; D014640:Vancomycin