Elimination of cefotaxime using polysulfone and polyacrylonitrile-derived filters: An in vitro assessment

Abstract

Continuous renal replacement therapy (CCRT) efficiently eliminates cefotaxime. To our knowledge, there are no previous in vitro studies dealing with the disposition of cefotaxime. We studied the elimination of cefotaxime by two filters in a model mimicking a session of CRRT using the NeckEpur® technology. The ST150®-polyacrylonitrile filter with the Prismaflex, Baxter-Gambro, and the AV1000®-polysulfone filter with the Multifiltrate Pro, Fresenius, were studied. Continuous filtration used a flowrate of 1 L/h in post-dilution only. Simulated blood flowrate was set at 200 mL/min. Routes of elimination were assessed using the NeckEpur® technology. Cefotaxime concentrations were measured using ultra high-performance liquid chromatography, and tandem mass spectrometry. Two sessions were performed using the ST® filter and three using the AV® filter. Stability of cefotaxime during 6 h was assessed in triplicate with a mean variation of concentrations of 2.4 ± 1.5% at the end of the study. The mean measured initial concentration in the central compartment (CC) for the five sessions was 52.4 mg/L. The mean amount eliminated from the CC at the end of the sessions using the ST150®-polyacrylonitrile and the AV1000®-polysulfone filters were 72% and 73%, respectively. The clearances of cefotaxime from the central compartment (CC) were 1.1 and 1.2 L/h, respectively. The mean sieving coefficient were 0.99 and 0.99, respectively. The mean percentages of the amount eliminated from the CC by filtration/adsorption were 87/13% and 92/8%, respectively. Both adsorption percentages were below 15%. We conclude neither the ST150®-polyacrylonitrile nor the AV1000®-polysulfone filters result in clinically significant adsorption of cefotaxime.

Pharmacokinetic of ceftazidime‐avibactam in a critically ill patient under high‐volume continuous venovenous haemodiafiltration: A first paediatric case report

“…This might also be explained by interactions on the filter such as desorption or adsorption that could reduce the elimination of avibactam. Adsorption has already been described in cephalosporin in in vitro studies 19 …”

“…Adsorption has already been described in cephalosporin in in vitro studies. 19 The adult studies also demonstrated significant alterations of pharmacokinetics in ill adult patients under CRRT compared to healthy volunteers. 6 Moreover CRRT was reported as an independent predictor of resistance development and clinical failure in patients treated with ceftazidime-avibactam for K. pneumoniae infection.…”