title: Pharmacokinetics of moxifloxacin and levofloxacin in intensive care unit patients who have acute renal failure and undergo extended daily dialysis.
abstract: Extended daily dialysis (EDD) is increasingly popular in the treatment of acute renal failure (ARF). EDD could remove drugs to a much different degree compared with intermittent standard hemodialysis or continuous renal replacement therapies; however, there are only scarce data on how EDD influences the pharmacokinetics of frequently used drugs. The aim of this study was to determine the pharmacokinetics of two quinolone antibiotics in patients who had anuric ARF and were being treated with EDD. Adult patients who were in the intensive care unit at a tertiary care university hospital and receiving moxifloxacin (n = 10) or levofloxacin (n = 5) therapy were included. The antibiotics were administered intravenously 8 h (400 mg of moxifloxacin) or 12 h (500 mg of levofloxacin) before EDD to study pharmacokinetics off and on EDD. Treatment lasted 8 h; blood and dialysate flow rates were 160 ml/min. In addition to standard pharmacokinetic parameters, the total dialysate concentration of both drugs was measured using a technically simple single-pass batch dialysis system for EDD. Moxifloxacin pharmacokinetics in critically ill patients who had ARF and were undergoing EDD were similar to those in healthy subjects without renal impairment. Levofloxacin, although removed by EDD, had a lower total clearance compared with healthy subjects. According to these findings, anuric critically ill patients who are undergoing EDD should be treated with the standard dosage of moxifloxacin (400 mg/d intravenously). The levofloxacin dosage, however, should be reduced according to the intensity of renal replacement therapy.
authors: Division of Nephrology, University Hospital Ulm, Ulm, Germany.
authors: David
authors: D
authors: Czock
authors: Cordula
authors: C
authors: Hüsig-Linde
authors: Anita
authors: A
authors: Langhoff
authors: Timo
authors: T
authors: Schöpke
authors: Carsten
authors: C
authors: Hafer
authors: Kirsten
authors: K
authors: de Groot
authors: Stefanie
authors: S
authors: Swoboda
authors: Ernst
authors: E
authors: Kuse
authors: Hermann
authors: H
authors: Haller
authors: Danilo
authors: D
authors: Fliser
authors: Frieder
authors: F
authors: Keller
authors: Jan T
authors: JT
authors: Kielstein
mesh_terms: D058186:Acute Kidney Injury / Q000188:drug therapy / Q000628:therapy*; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics*; D001002:Anuria; D001372:Aza Compounds / Q000493:pharmacokinetics*; D003422:Critical Care; D016638:Critical Illness / Q000628:therapy; D005260:Female; D024841:Fluoroquinolones; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D064704:Levofloxacin; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D000077266:Moxifloxacin; D009102:Multiple Organ Failure / Q000517:prevention & control; D015242:Ofloxacin / Q000493:pharmacokinetics*; D011804:Quinolines / Q000493:pharmacokinetics*; D006435:Renal Dialysis; D018805:Sepsis / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D011804:Quinolines; D064704:Levofloxacin; D015242:Ofloxacin; D000077266:Moxifloxacin