Does Beta-lactam Pharmacokinetic Variability in Critically Ill Patients Justify Therapeutic Drug Monitoring? A Systematic Review

Sime, Fekade Bruck; Roberts, Michael S; Peake, Sandra L; Lipman, Jeffrey; Roberts, Jason A

doi:10.1186/2110-5820-2-35

Annals of Intensive Care

Table 2 Pharmacokinetic parameters of selected beta-lactam antibiotics in critically ill patients undergoing CRRT

From: Does Beta-lactam Pharmacokinetic Variability in Critically Ill Patients Justify Therapeutic Drug Monitoring? A Systematic Review

Antibiotic	Patients	Dose	Renal replacement modalities		Pharmacokinetic data
Antibiotic	Patients	Dose	RRT	Dialyzer	Q _B(mL/min)	Q _UF(mL/min)	Q _DF(mL/h)	C _max(mg/L)	t _H(h)	Vd(l/kg)	AUC (mg·h/L)	CL _tot(mL/min)	CL _RRT(mL/min)	Sc/Sa	Ref.
Cefepime	4	2 g q8h	CVVH or CVVHD	PAN or PS	140-250	16.7-35	500-1000	100.5 l	4.6	0.6		111.5	27.2	0.76	[67]
	5	1-4 g q12h or q24h	CVVH	PAN	150	16		44.6 - 94.9	12.9	0.46	834.7 -1,677.8	35.9	13	0.86	[66]
	7	1-4 g q12h or q24h	CVVHDF	PAN	150	17	857-1020	25.7 -90.8	8.6	0.34	344.9 -1,306.8	46.8	26	0.78	[66]
	8	2 g q12h	CVVH or CVVHDF	AN69	150	25.7*	1610*	43	6.17	0.55	379	72.8*			[84]
Ceftazidime	12	2 g q8h	CVVH	PS	143	47		58.2	4.3	0.52*	344	98.7	32.1	0.69	[70]
	7	3 g q24h	CVVDHF	AN69	150	25	1000		4	0.27*	2514	62	33.6	0.81	[69]
	4	1-2 g q6h	CVVH or CVVHDF	AN69 or PS	130-140	25	500-1000	53.9-112	6.4	0.67		35.5-333.8	5-65.6	0.93	[82]
	12	2 g q12h	CVVH or CVVHDF	AN69	150	25.7*	1610*	78	7.74	0.37	536	36.4*			[84]
Meropenem	8	500 mg q12h	CVVH	AN69	10	26.7		39.5	3.63		105.3	82.94	24.42	0.91	[71]
	5	1 g q12h	CVVH	AN69	150	16.7–33.3			5.16	0.39*	246	4.3	1.96	0.93	[86]
	5	1 g q12h	CVVDHF	AN69	150	16.7 – 25	1000-1500		5.16	0.39*	246	4.3	1.96	0.93	[86]
	10	1 g q8h	High volume CVVH	AN69	250	66.7-100		56.6	4.3	0.2	166.5	100	58.3	0.93	[72]
	15	0.5-1 g q8h or q12h	CVVHDF	AN 69	90-150	0.17-4.5	600-1500		5.1	0.47*		75	26.7	0.65	[87]
	5	0.5 g q12h	CVVH	PAN	200	25-30		24.5	6.37	0.37	129.5	4.57	1.03	0.63	[88]
	9	0.5 g q8h or q12h	CVVH	AN69	150-170	1.7-2.5		38.9	8.7	0.17*		52	22	1.17	[72]
	9	1 g Stat	CVVH	PS	150	45.8		28.1		0.37*	118	143.7	49.7	0.24	[89]
Piperacillin/ tazobactam	6	4 g q12h/0.5 g q12h	CVVH	PS	100	13.3			7.7/13.9			64.8/40.3			[90]
			CVVHDF				1000		6.7/11.6			84.3/52.2
			CVVHDF				2000		6.1/9.4			91.3/62.5
	8	2 g/0.25 g or 4 g/0.5 g	CVVHD	AN69	150	1.3-3.3	1500		4.3/5.6	0.31/0.24		47/29.5	22/17	0.87/0.64	[91]
Ceftriaxone	6	2-4 g q24h	CVVH	PA	100-150	20-30			10.8	0.45*			16.6	0.69	[77]
Flucloxacillin	10	4 g q8h	CVVH	PA	169	57		139.1-179.7	4.9	0.69*	568	117.2		0.21	[79]

Q_B, blood flow rate; Q_UF, ultrafiltration rate; Q_DF, dialysate flow rate; RRT, renal replacement therapy; Sc, sieving coefficient; Sa, saturation coefficient; Vd, volume of distribution; CL, clearance; C_max, peak serum concentration; t_H, half-life; AUC, area under the concentration vs time curve; CVVH, continuous venovenous hemofiltration; CVVHD, continuous venovenous hemodialysis; CVVHDF, continuous venovenous hemodiafiltration; PAN, polyacrylonitrile; PS, polysulfone; PA, polyamide; *Data were converted considering 70 kg body weight.

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