Journal Article

Does haemodialysis significantly affect serum linezolid concentrations in critically ill patients with renal failure? A pilot investigation

Enrico Fiaccadori, Umberto Maggiore, Carlo Rotelli, Roberto Giacosa, Elisabetta Parenti, Edoardo Picetti, Paola Manini, Roberta Andreoli and Aderville Cabassi

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 21, issue 5, pages 1402-1406
Published in print May 2006 | ISSN: 0931-0509
Published online February 2006 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfl048
Does haemodialysis significantly affect serum linezolid concentrations in critically ill patients with renal failure? A pilot investigation

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Background. Previous studies have shown that a single haemodialysis (HD) session removes about one-third of the linezolid dose administered, but it is unknown whether in critically ill patients with renal failure on intermittent HD, this removal adversely affects serum antibiotic concentrations.

Methods. Five male critically ill patients (mean age 75 years, range 68–82; APACHE II score 26.4, range 23–29; survival 2/5) with sepsis and renal failure on haemodialysis, were administered i.v. linezolid, 600 mg every 12 h. Serum antibiotic levels were measured by high-performance liquid chromatography/mass spectrometry. We classified trough concentrations as ‘with HD’ when a HD session was performed after linezolid infusion, and ‘without HD’ otherwise. We also computed population pharmacokinetics while patients were on-dialysis and off-dialysis.

Results. A total of 222 serum linezolid concentrations were available over 36 days of antibiotic therapy, during which patients underwent 31 HD sessions. Trough serum linezolid levels averaged 5.83 mg/l (range 1.48–15.84), exceeding 4.0 mg/l in 68.9% of the samples; however, the trough levels ‘with HD’ were lower than those ‘without HD’ (4.68 mg/l [range 1.48–9.07] vs 6.74 mg/l [range 2.04–15.84], P<0.001). Clearance and half-life were 6.0 l/h and 4.0 h, respectively, while patients were on-dialysis, and 4.4 l/h and 7.3 h, respectively, when they were off-dialysis.

Conclusions. HD can significantly reduce serum linezolid levels in critically ill patients with renal failure.

Keywords: critical illness; dosage guidelines; haemodialysis; linezolid; renal failure

Journal Article.  2787 words.  Illustrated.

Subjects: Nephrology

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