Elimination of three doses of gentamicin over three consecutive days using a polyacrylonitrile-derived filter: An in vitro assessment

Abstract

Introduction: Adsorption of gentamicin in a polyacrylonitrile filter was previously evidenced in a session lasting 6 h using the NeckEpur model. We extended the study over three consecutive days to mimic the 72-h life span of a filter. Methods: Prismaflex® monitor and ST150® filter were used in the continuous diafiltration (CDF) mode at a 2.5 L/h flowrate. The daily session started with a 6-h session of CDF. Thereafter, the 5-L central compartment was changed using a bag free of gentamicin to assess gentamicin release over the following 18 h. Experiments were repeated on Day 2 and stopped at the end of the 6-h session of CDF on Day 3. The experiment was performed in duplicate. Results: At a 2.5 L/h diafiltration flowrate, the mean daily clearances of gentamicin were 5.5, 4.0, and 3.3 L/h, respectively. The mean diafiltration and adsorption ratios in the daily elimination of gentamicin were 32/68%, 58/42%, and 88/12%, respectively. During days 1 and 2, the mean amount of gentamicin released from the ST150® filter were 14 and 34 mg, respectively. Conclusion: The pharmacokinetics of gentamicin over 3 days is strongly altered by adsorption in the same filter with a progressive decrease of elimination by adsorption, suggesting saturation of the filter. One limitation of our study results from the mode of administration using a bolus dose instead of an infusion over 30 min. Adsorption adds a clearance to those of diafiltration. The time-dependency of gentamicin clearance precludes using a constant dosage regimen over the filter’s life span.

Disposition of gentamicin and amikacin in extracorporeal membrane oxygenation using a heparin-coated filter: An in vitro assessment

“…Recently, using Hemosol ® , we reported the elimination of three consecutive doses of gentamicin by the same filter over a period of 3 days during a session of continuous hemofiltration. 3 We believe that, using the NeckEpur ® method, these results can be extended to ECMO and being useful to assess early adsorption which may result in therapeutic failure as well as late release which may result in drug accumulation, possibly inducing drug toxicity.…”

“…There are consistent results of in vitro studies evidencing adsorption of aminoglycosides in filters used in CRRT, including gentamicin, tobramycin, and amikacin. 1–4,19–22 Therefore, we considered mandatory to assess adsorption of aminoglycosides in ECMO circuits.…”

“…Previous studies consistently showed adsorption of aminoglycosides in continuous renal replacement therapy (CRRT). [1][2][3][4] We are not aware of any in vitro study having addressed the disposition of gentamicin and amikacin in extracorporeal membrane oxygenation (ECMO) devices.…”

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

“…However, in vitro study allows controlling several variables; consequently, results are highly reproducible as shown in Table 1 and clearly documented in another NeckEpur ® study for gentamicin. 13 In one session, the study ended at 180 min, before the selected duration, 360 min. However, there is a consensus that adsorption is an early occurring phenomenon achieved within almost 120 min post-initiation of CRRT session.…”

“…12 The present study suffers some limitations. 13 Only two sessions were performed for each filter. However, in vitro study allows controlling several variables; consequently, results are highly reproducible as shown in Table 1 and clearly documented in another NeckEpur ® study for gentamicin.…”