Pharmacokinetics of ampicillin during venovenous extracorporeal membrane oxygenation: A case report

Abstract

The presence of extracorporeal membrane oxygenation (ECMO) in addition to underlying critical illness can affect the pharmacokinetics and pharmacodynamics of drugs that are often required to treat this patient population. While ampicillin is the preferred agent for the treatment of susceptible Enterococcus faecalis infections, there are no in vivo pharmacokinetic studies regarding ampicillin dosing in patients receiving ECMO. This case report consists of two patients on venovenous ECMO with E. faecalis bloodstream infections in which ampicillin serum concentrations were measured. Pharmacokinetic parameters were calculated using a one compartment open model. Ampicillin trough levels were 5.87 and 39.2 mg/L for patients A and B, respectively. Based on these results, ampicillin concentrations were found to be above the minimum inhibitory concentration (MIC) for 100% of the dosing interval. The findings of this case report demonstrate that therapeutic concentrations of ampicillin can be obtained in patients on ECMO and therapeutic drug monitoring can be utilized to ensure adequate serum concentrations are achieved.