Pharmacokinetics of teicoplanin during continuous hemofiltration with a new and a 24-h used highly permeable membrane: rationale for therapeutic drug monitoring-guided dosage.
OBJECTIVE
Continuous venovenous hemofiltration (CVVH) is widely used in the management of critically ill patients, but only few administration guidelines for antimicrobial drugs are available. It is unclear whether the use of a filter for more than 24 hours might lead to less efficient extraction. This study describes the pharmacokinetics of teicoplanin during CVVH using a highly permeable membrane.


METHODS
Pharmacokinetics of teicoplanin during continuous hemofiltration with a new (group 1) and a 24-h used (group 2), highly permeable polyamide membrane were assessed in 3 patients.


RESULTS
The teicoplanin serum concentrations (44.0 +/- 18.5 mg/l vs 109.5 +/- 34.5 mg/l) and half-life of teicoplanin (4.6 +/- 1.1 h vs 5.2 +/- 0.7 h) differed significantly between the 2 groups indicating a smaller elimination of the drug on the second day. Substantial binding of teicoplanin to filter membranes could explain this observation.


CONCLUSIONS
The results suggest that daily adjustment of the dosage is necessary to achieve sufficient teicoplanin concentrations and a fixed dosage recommendation is not suitable for this drug.
Meyer
B
B
Department of Internal Medicine I, Division of Infectious Diseases, University of Vienna, Austria.
Traunmüller
F
F
Hamwi
A
A
Hollenstein
U M
UM
Locker
G J
GJ
Sperr
W R
WR
Staudinger
T
T
Thalhammer-Scherrer
R
R
Burgmann
H
H
Thalhammer
F
F
D000900:Anti-Bacterial Agents / Q000097:blood / Q000493:pharmacokinetics*; D019540:Area Under Curve; D006207:Half-Life; D006440:Hemofiltration / Q000379:methods; D006801:Humans; D008567:Membranes, Artificial; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D017334:Teicoplanin / Q000097:blood / Q000493:pharmacokinetics*
D000900:Anti-Bacterial Agents; D008567:Membranes, Artificial; D017334:Teicoplanin