Abstract: TH-PO0829
Dosing of Anti-Infective Drugs During Therapeutic Plasma Exchange in Sepsis: A Narrative Review of Considerations for Practical Application
Session Information
- Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)
- 1900 Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)
Authors
- Nachtigall, Maj-Britt, Technische Universitat Braunschweig, Brunswick, NDS, Germany
- Kielstein, Jan T., Stadtisches Klinikum Braunschweig gGmbH, Brunswick, NDS, Germany
- Scherneck, Stephan, Technische Universitat Braunschweig, Brunswick, NDS, Germany
- Schmidt, Julius, Klinikum Oldenburg AoR, Oldenburg, NDS, Germany
- David, Sascha, UniversitatsSpital Zurich, Zürich, ZH, Switzerland
- Flechtner, Jan, Stadtisches Klinikum Braunschweig gGmbH, Brunswick, NDS, Germany
Background
Therapeutic plasma exchange (TPE) is used for a wide range of indications, including the treatment of critically ill patients. Besides the removal of inflammatory mediators and pathologic plasma components, TPE may also result in unintended elimination of anti-infective drugs. As adequate antimicrobial exposure is essential in sepsis, altered pharmacokinetics during TPE may contribute to subtherapeutic drug concentrations and treatment failure.
Methods
A structured literature review was conducted using PubMed, Scopus, Cochrane Library and Google Scholar. English- and German-language publications from 1980 to 2026 reporting pharmacokinetic data of anti-infective drugs during TPE in humans were included. Extracted parameters included anti-infective drug class, TPE modality, timing of drug administration, and reported drug elimination.
Results
Of 120 identified publications, 32 met inclusion criteria. Low volume of distribution, high protein binding, and short distribution half-life were associated with increased extracorporeal drug removal. Aminoglycosides and glycopeptides appeared particularly affected, whereas drugs with larger distribution volumes were less susceptible to elimination during TPE.
Conclusion
TPE may substantially alter plasma concentrations of selected anti-infective drugs in patients with sepsis and septic shock. Timing of administration relative to TPE should therefore be considered in clinical practice. Whenever possible, TPE should not be performed in close temporal proximity to the administration of the initial anti-infective dose. Further prospective studies are needed due to the limited pharmacokinetic data available for anti-infective drugs during TPE in sepsis.
Figure 1. Reported anti-infective drug removal during TPE. Squares indicate mean removal and bars represent variability between studies. The color gradient reflects increasing drug removal from low (green) to high (red).