Optimal levofloxacin dosing regimens in critically ill patients with acute kidney injury receiving continuous renal replacement therapy.

Abstract

To determine appropriate dosing of levofloxacin in critically ill patients receiving continuous renal replacement therapy (CRRT). All necessary pharmacokinetic and pharmacodynamic parameters from critically ill patients were obtained to develop mathematical models with first order elimination. Levofloxacin concentration-time profiles were calculated to determine the efficacy based on the probability of target attainment (PTA) of AUC24h/MIC ≥50 for Gram-positive and AUC24h/MIC ≥125 for Gram-negative infections. A group of 5000 virtual patients was simulated and tested using Monte Carlo simulations for each dose in the models. The optimal dosing regimens were defined as the dose achieved target PTA at least 90% of the virtual patients. No conventional, FDA approved regimens achieved at least 90% of PTA for Gram-negative infection with Pseudomonas aeruginosa at MIC of 2mg/L. The successful dose (1750mg on day 1, then 1500mg q 24h) was far exceeded the maximum FDA-approved doses. For Gram-positive infections, a levofloxacin 750mg q 24h was sufficient to attain PTA target of ~90% at the MIC of 2mg/L for Streptococcus pneumoniae. Levofloxacin cannot be recommended as an empiric monotherapy for serious Gram-negative infections in patients receiving CRRT due to suboptimal efficacy.