Pharmacokinetics of Commonly Used Antimicrobials in Critically Ill Adults During Extracorporeal Membrane Oxygenation: A Systematic Review

Antibiotics and ECMO in the Adult Population—Persistent Challenges and Practical Guides

“…Sampling was performed after the second and third caspofungin dose, finding no significant pharmacokinetics [114]. Hence, the usual dosing of 70 mg loading with subsequent 50 mg/d dosing may be sufficient [111]. Prior studies have noted a Vd for caspofungin within normal parameters in these patients [81].…”

“…Notably, 6.1% of patients did not achieve target MIC compared to 0% of those receiving a higher-dose regimen [80]. High dosage may be considered in patients necessitating higher MICs [111]. Notably, in one study involving patients undergoing renal replacement therapy, MIC levels < 1 were associated with increased mortality [112].…”

“…Imipenem, also within the carbapenem classification, has also been studied. One study including 247 ECMO patients found lower plasma levels and higher dosing recommendable [111]. Others trialed 0.5 g every 6 h in 10 ECMO vs. 18 non-ECMO patients, sampling after the fourth dose and finding an increased distribution volume yet decreased clearance, which also recommended increased dosing [112].…”

“…Linezolid patients receiving linezolid may also show a tendency to not achieve desired plasma levels (35% vs. 15%) [80]. Nevertheless, if selected, a linezolid loading dose of 600 mg followed by 1800 mg/d continuous infusion is recommended [111].…”

“…However, in one observational study on 12 ECMO patients, micafungin sampling at 1, 3, 5, 8, 18 and 24 h after infusion yielded no differences in clearance or distribution volume [115]. No consensus on dosing recommendations for micafungin were available at the time of writing [111].…”