Pharmacokinetics of levofloxacin during continuous venovenous hemodiafiltration and continuous venovenous hemofiltration in critically ill patients.
OBJECTIVE
To assess the pharmacokinetics of levofloxacin during continuous venovenous hemodiafiltration (CVVHDF) and continuous venovenous hemofiltration (CVVH).


METHODS
Nonrandomized pharmacokinetic evaluation.


METHODS
University surgical intensive care unit.


METHODS
Six critically ill patients.


METHODS
Five patients received levofloxacin 500 mg/day and one patient received levofloxacin 125 mg/day All patients received continuous renal replacement therapy: CVVHDF on day 1 and CVVH on day 2, using an acrylonitrile hollow-fiber 0.9-m2 filter, constant blood flow rate of 90 ml/minute, substitution flow rate of 1 L/hour predilution, and dialysate flow rate of 1 L/hour (CVVHDF).


RESULTS
Serum, ultrafiltrate, and dialysate concentrations of levofloxacin were determined by high-performance liquid chromatography. Extracorporeal clearance was 26.05 +/- 4.66 ml/hour during CVVHDF and 15.71 +/- 2.73 ml/hour during CVVH (p<0.05). Elimination half-life was 28.08 +/- 4.5 hours and 45.9 +/- 17.7 hours, and distribution volume was 1.51 +/- 0.52 L/kg and 1.42 +/- 0.42 L/kg for CVVHDF and CVVH, respectively. Saturation was 0.76 +/- 0.13 for CVVHDF versus a sieving coefficient of 0.77 +/- 0.16 for CVVH.


CONCLUSIONS
Marked extracorporeal elimination of levofloxacin occurs, requiring a dosage adjustment that can be calculated from the characteristics of CVVH and CVVHDF.
Guenter
Sven G
SG
Department of Surgery, Luebeck Medical University, Germany.
Iven
Heiko
H
Boos
Carsten
C
Bruch
Hans-Peter
HP
Muhl
Elke
E
D058186:Acute Kidney Injury / Q000097:blood; D000368:Aged; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics*; D019540:Area Under Curve; D002851:Chromatography, High Pressure Liquid; D016638:Critical Illness / Q000628:therapy*; D005260:Female; D006207:Half-Life; D017583:Hemodiafiltration / Q000379:methods*; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D064704:Levofloxacin; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D015242:Ofloxacin / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics*
D000890:Anti-Infective Agents; D064704:Levofloxacin; D015242:Ofloxacin