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Abstract: TH-PO355

Vancomycin and Teicoplanin Clearance During an In Vitro Model of Continuous Venovenous Hemofiltration Using Different Hemofilters

Session Information

Category: Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)

  • 1800 Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)

Authors

  • Godi, Ilaria, University of Padova, IRRIV, San Bortolo Hospital, Vicenza, Italy
  • Lorenzin, Anna, IRRIV, Vicenza, Italy
  • De Rosa, Silvia, San Bortolo Hospital, Vicenza, Italy
  • de Cal, Massimo, San Bortolo Hospital, Vicenza, Italy
  • Ronco, Claudio, University of Padova, IRRIV, San Bortolo Hospital, Vicenza, Italy
Background

Continuous renal replacement therapies (CRRT) can affect pharmacokinetic behavior of antibiotics. The factors that need to be considered are related to the drug characteristics, CRRT features and patient status. Particularly, the type of membrane can play a major role in drug removal.
The aim of this study was to evaluate in an in vitro system the convective and adsorptive drug clearance of vancomycin (VAN) and teicoplanin (TEC) during continuous venovenous hemofiltration (CVVH) with polysulfone (PS), polymethylmethacrylate (PMMA) and polyacrylonitrile (PAN) filters.

Methods

VAN and TEC clearance was assessed in vitro in blood from healthy donors. Closed circuit simulating CVVH was performed using PS, PMMA and PAN mini-filters at 10ml/min ultrafiltrate and 50 ml/min blood flow rates. The duration of the experiment was of 360 min. Samples were collected at 5, 10, 30, 60, 120, 240 and 360 minutes from in-flow, out-flow and ultrafiltrate line; antibiotic concentrations were measured with biochemistry analyzer. Convective clearance was evaluated in terms of sieving coefficient (SC), and adsorptive clearance was calculated using mass balance analysis.

Results

VAN and TEC blood SC are shown in Fig 1, as well as the reduction ratio of plasmatic concentrations for each membrane.
During CVVH using PS, PMMA and PAN membranes, the estimated total adsorbed mass per surface area for VAN was 36.52mg/m2, 11.33mg/m2 and 6.97mg/m2, and for TEC was 98.17mg/m2, 51.33mg/m2 and 9.77 mg/m2, respectively.

Conclusion

Our findings show that during CRRT both convective and adsorptive mechanisms have a role in antibiotics clearance. When dosing patients on CRRT, physicians should take into account not only CRRT flow rate settings and modality but also drug-membrane interaction.