Vol.67 No.1 January 2019
Pharmacokinetics of vancomycin in children undergoing combined extracorporeal membrane oxygenation and continuous venovenous hemodiafiltration therapy
1)Department of Pharmacy, Tokyo Metropolitan Children's Medical Center
2)Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center
Abstract
【Background】 The pharmacokinetics of antimicrobial agents in children undergoing extracorporeal circulation have a large priming volume to circulating blood volume, which results in a significant increase of the distribution volume (Vd).
The increase in the Vd is significant. However, there are few studies on the pharmacokinetics of drugs in children undergoing extracorporeal circulation. We examined the pharmacokinetics of vancomycin (VCM) in children undergoing combined extracorporeal membrane oxygenation (ECMO) and continuous venovenous hemodiafiltration (CHDF) therapy.
【METHODS】Patients aged 15 years or younger who were undergoing combined ECMO and CHDF therapy and receiving vancomycin between January 2013 and March 2017 were included in this study; the blood drug levels were measured at two time-points after administration of VCM. The Vd, elimination rate constant (ke) and VCM clearance (CLvcm) were calculated by the Sawchuk-Zaske (SZ) method.
【RESULTS】 The median age of the 9 subjects (5 males, 4 females) was 3.6 [interquartile range (IQR) 0.2-8.0] years. The median body weight was 12.9 (IQR 3.0-22.5) kg. The median Vd calculated by the SZ method was 0.7 (IQR 0.5-1.0) L/kg. The median ke was 0.06 (IQR 0.04-0.2) hr-1, the median CLvcm was 0.06 (IQR 0.04-0.2) L/hr/kg, and the median dose required for area under the time-concentration curve = 400 was 23.6 (IQR 14.6-63.0) mg/kg/day.
【Discussion】 Increased Vd was observed in some cases. Adjustment of the administration interval based on the residual renal function and setting of the CHDF, and consideration to increasing each dose might be useful for the administration design at the time of extracorporeal circulation in children.
Key word
pediatric, extracorporeal membrane oxygenation, continuous venovenous hemodiafiltration, vancomycin
Received
April 9, 2018
Accepted
August 22, 2018
Jpn. J. Chemother. 67 (1): 38-43, 2019
