Doripenem treatment during continuous renal replacement therapy.
Antimicrob Agents Chemother. 2015 Dec 28;
Authors: Vossen MG, Wenisch JM, Maier-Salamon A, Fritsch A, Saria K, Zuba C, Jilch S, Lemmerer R, Unger M, Jaehde U, Jäger W, Thalhammer F
Abstract
OBJECTIVES: Doripenem is a broad spectrum parenteral carbapenem with enhanced activity against Pseudomonas aeruginosa. While initial dosing recommendations in renally competent patients and patients undergoing continuous renal replacement therapy (cRRT) was 500 mg q8, the dose for renally competent patients has been updated to 1 g q8 in June 2012. There is no updated data for dosing in continuous renal replacement therapy. The original dosing regimen for cRRT patients was based on non-septic patients, while newer publications choose comparingly low target concentrations for a carbapenem. Thus there is urgent need for updated dosing recommendations during cRRT.
PATIENTS: In the presented trial we included thirteen oliguric septic patients undergoing cRRT in an intensive care setting. Five patients were treated with haemodiafiltration or haemodialysis respectively, while three patients received a hemofiltration treatment. All patients received 1g doripenem every eight hours. Doripenem plasma and ultrafiltrate concentrations were measured over 48 hours.
RESULTS: Mean heamofilter clearance was 36.53 ml/min, the mean Volume of distribution was 59.26 L. The steady state trough levels were found at 8.5 mg/L with no considerable accumulation.
CONCLUSION: Based on pharmacokinetic and pharmacodynamic considerations we propose a 1g q8 regimen, which may be combined with a loading dose of 1.5 to 2 g in critically ill patients.
PMID: 26711775 [PubMed - as supplied by publisher]