A successful daptomycin and micafungin dosing strategy in veno‐venous ECMO and continuous renal replacement

Abstract

What is known and objective Studies have demonstrated that ECMO leads to pharmacokinetic changes, with alterations in volume of distribution, clearance and drug sequestration by the circuit. We describe a successful dosing approach for daptomycin and micafungin for the treatment of VRE faecium bacteremia and C. glabrata fungemia in a patient receiving veno‐venous ECMO and CRRT. Case summary We report a case of a patient with ARDS on veno‐venous ECMO complicated by VRE faecium bacteremia and C. glabrata fungemia. The patient was treated with daptomycin 10 mg/kg every 24 h and micafungin 150 mg every 24 h for 14 days. Key observations included the documented bacteremia and fungemia clearance without the need for ECMO circuit exchange. What is new and conclusion This case report demonstrates successful bacteremia and fungemia clearance in an adult without the need for ECMO circuit exchange. It also highlights the need for more research to identify optimal antimicrobial dosing strategies in similar scenarios.

Antifungals in Patients With Extracorporeal Membrane Oxygenation: Clinical Implications

“…In 12 patients, micafungin was not extracted by the ECMO oxygenator on day 1 and day 4 [ 34 ], but the micafungin concentration was reported to be reduced in another study in patients with ECMO by 23% [ 15 ]. An increased dosage of 150 mg of micafungin was successful in a patient with Candida glabrata fungemia receiving veno-venous ECMO and continuous RRT [ 35 ].…”

Optimizing pharmacotherapy regimens in adult patients receiving extracorporeal membrane oxygenation: A narrative review for clinical pharmacists

“…54,55 For treatment of severe infections, higher daily doses of micafungin (150-200 mg every 24 h) have been recommended. 56 Caspofungin is a highly lipophilic antifungal agent with high degree of ECMO circuit sequestration, but no significant PK alterations were reported between patients on ECMO support and matched controls. 57 Based on the limited data with caspofungin, no dose adjustments are recommended for patients receiving ECMO support.…”

“…While drug loss with micafungin in the ECMO circuit has been reported up to 74%, an observational study found no differences in PK parameters on Days 1 and 4 of treatment in patients on ECMO 54,55 . For treatment of severe infections, higher daily doses of micafungin (150–200 mg every 24 h) have been recommended 56 . Caspofungin is a highly lipophilic antifungal agent with high degree of ECMO circuit sequestration, but no significant PK alterations were reported between patients on ECMO support and matched controls 57 .…”

Antifungal Dosing in Critically Ill Patients on Extracorporeal Membrane Oxygenation

“…A case report of micafungin described the successful treatment of a Candida glabrata fungaemia in an adult critically ill patient receiving VV ECMO and continuous renal replacement using the higher dose of 150 mg every 24 h [ 79 ].…”