Revista de Cuidados Farmacêuticos e Sistemas de Saúde
Acesso livre
ISSN: 2376-0419
ISSN: 2376-0419
Florian Scheer, Marc Bodenstein, Kristin Engelhard, Patrick Schramm and Irene Krämer
In sepsis an early time point of administration, adequate choice of an antibiotic drug and correct dosage are crucial for survival. Acute renal failure in severe sepsis can be treated by continuous renal replacement therapy but interferes with the pharmacokinetics of antibiotic drugs. The aim of the present study was to investigate the efficacy and safety of an antibiotic therapy with piperacillin/tazobactam and ciprofloxacin. In a single-center, prospective, open-label study a total of 24 patients with acute renal failure treated with continuous venovenous haemodialysis (CVVHD) or haemodiafiltration (CVVHDF) were enrolled in a clinical trial. Serum concentrations (Cmax, Cmin) and pharmacokinetic parameters of piperacillin and ciprofloxacin were analyzed. Optimum exposure to piperacillin is expected when serum concentrations are maintained 4-5 times higher than the minimum inhibitory concentration (MIC), i.e. above 64 mg/l. Optimum exposure to ciprofloxacin is given when the ratio (AUIC) of AUC and MIC is ≥ 125 h per dosing interval. In addition the Cmax/MIC ratio should amount to ≥ 10. Plasma concentrations lower than 64 mg/l were determined in 10 out of 21 patients treated with piperacillin. Nine out of 20 patients treated with ciprofloxacin had a calculated AUIC ≥ 125 h and a Cmax/MIC ratio ≥ 10. In critically ill patients undergoing CVVD or CVVDF piperacillin/tazobactam dosing should be increased to 4/0.5 g four times daily and ciprofloxacin dosing to 400 mg twice daily. Therapeutic drug monitoring of antibiotic therapies would be reasonable in these patients. The trial is registered at clinicaltrialsregister.eu ID: 2010-021369-66.