Abstract
The aim of this study was to assess the in vitro adsorption of antibiotics: vancomycin, gentamicin, ciprofloxacin and tigecycline on both polyethyleneimine-treated polyacrylonitrile membrane of AN69ST filter and polysulfone membrane of AV1000 filter using porcine blood as a model close to in vivo conditions. The porcine blood with antibiotic dissolved in it was pumped into hemofiltration circuit (with AN69ST or AV1000 filter), ultrafiltration fluid was continuously returned to the reservoir containing blood with antibiotic. Blood samples to determine antibiotic concentrations were taken at minutes 0, 5, 15, 30, 45, 60, 90 and 120 from the pre- blood pump of the hemofiltration circuit. To assess possible spontaneous degradation of the drug in the solution there was an additional reservoir prepared for each antibiotic, containing blood with the drug, which was not connected to the circuit. In the case of vancomycin, ciprofloxacine and tigecycline, a statistically significant decrease in the drug concentration in the hemofiltration circuit in comparison to initial value as well as to the concentrations in the control blood was observed, both for polyacrylonitrile and plolysulfone membrane. In the case of gentamicin, significant adsorption was noted only on polyacrylonitrile membrane. Our studies demonstrated that in full blood adsorption of antibiotics may be big enough to be of clinical significance. In particular in the case of polyacrylonitrile membrane.
Highlights
Optimum antibiotic dosing in the treatment of severe infections and septic shock is of key importance for achieving a therapeutic success; it remains, a major challenge in intensive therapy units
Our studies demonstrated that in full blood adsorption of antibiotics, both hydrophilic such as vancomycin and gentamicin and lipophilic such as ciprofloxacin and tigecycline may be big enough to be of clinical significance
The comparison of adsorption during continuous veno-venous hemofiltration (CVVH) for antibiotics solved in full blood and for antibiotics solved in the crystalloid solution shows a significant role of blood proteins, especially for PS membranes, due to their strong affinity to bind proteins
Summary
Optimum antibiotic dosing in the treatment of severe infections and septic shock is of key importance for achieving a therapeutic success; it remains, a major challenge in intensive therapy units. This is due to the complexity and variability of antibiotic pharmacokinetics in critically ill patients as well as increasing antimicrobial resistance, and due to the use of medical technologies which have an effect on elimination of antibiotics from blood. There is a large group of patients who require continuous renal replacement therapy (CRRT)
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