Pharmacokinetics of moxifloxacin in patients undergoing continuous venovenous haemodiafiltration.
OBJECTIVE
Moxifloxacin is an 8-methoxy quinolone with a broad range of activity against clinically important pathogens. Therefore it is frequently administered in severe respiratory tract infections. Continuous venovenous haemodiafiltration (CVVHDF) is an important extracorporeal renal replacement therapy for intensive care patients suffering from sepsis and multiple organ failure. The aim of this study was to investigate the pharmacokinetics of intravenous moxifloxacin in anuric critically ill patients undergoing CVVHDF.


METHODS
Pharmacokinetic analysis was performed in nine intensive care patients with acute renal failure and suspected or proven infection sensitive to moxifloxacin, who received moxifloxacin 400 mg intravenously once daily. The concentration of moxifloxacin in serum and ultradiafiltrate was determined by HPLC.


RESULTS
Peak and trough serum concentrations were 3.76 +/- 2.02 mg/L and 0.24 +/- 0.14 mg/L, respectively, at the arterial port after the first dose. The mean elimination half-life was 9.87 +/- 3.26 h, the volume of distribution 270 +/- 133 L and the calculated AUC0-24 18.41 +/- 8.46 mg.h/L. Total clearance was 19.09 +/- 8.22 L/h and the clearance of haemodiafiltration 1.63 +/- 0.33 L/h.


CONCLUSIONS
The pharmacokinetics of moxifloxacin in critically ill patients with acute renal failure undergoing CVVHDF was comparable to healthy subjects and patients without renal impairment. We recommend 400 mg of intravenous moxifloxacin once per day in anuric patients during CVVHDF.
Fuhrmann
Valentin
V
Department of Internal Medicine 4, Intensive Care Unit, University Hospital Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. valentin.fuhrmann@akhwien.at
Schenk
Peter
P
Jaeger
Walter
W
Ahmed
Salwa
S
Thalhammer
Florian
F
D058186:Acute Kidney Injury / Q000150:complications / Q000378:metabolism* / Q000628:therapy; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics*; D001372:Aza Compounds / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics*; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy / Q000378:metabolism*; D002851:Chromatography, High Pressure Liquid; D004334:Drug Administration Schedule; D005260:Female; D024841:Fluoroquinolones; D017583:Hemodiafiltration / Q000379:methods*; D015312:Hemodialysis Solutions / Q000737:chemistry; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D000077266:Moxifloxacin; D011804:Quinolines / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics*; D012720:Severity of Illness Index
D000900:Anti-Bacterial Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D015312:Hemodialysis Solutions; D011804:Quinolines; D000077266:Moxifloxacin