Pharmacokinetics of fluconazole and ganciclovir as combination antimicrobial chemotherapy on ECMO: a case report

Dhanani, Jayesh; Lipman, Jeffrey; Pincus, Jason; Townsend, Shane; Livermore, Amelia; Wallis, Steven C.; Abdul‐Aziz, Mohd H.; Roberts, Jason A.

doi:10.1016/j.ijantimicag.2021.106431

Cited by 7 publications

(4 citation statements)

References 11 publications

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“…In ex vivo studies, no significant sequestration was reported for fluconazole 49 . A loading dose of fluconazole may be required for ECMO‐supported patients due to increased Vd seen in critically ill pediatric and adult patients 51 . Despite ex vivo studies demonstrating loss of voriconazole within the ECMO circuit, an observational retrospective study of 69 patients found no significant differences in attainment of drug exposure in patients receiving ECMO compared with patients not on ECMO 52 .…”

Section: Antimicrobialsmentioning

confidence: 98%

“…49 A loading dose of fluconazole may be required for ECMO-supported patients due to increased Vd seen in critically ill pediatric and adult patients. 51 Despite ex vivo studies demonstrating loss of voriconazole within the ECMO circuit, an observational retrospective study of 69 patients found no significant differences in attainment of drug exposure in patients receiving ECMO compared with patients not on ECMO. 52 In this study, 56% of patients in the ECMO group compared with 39% in the non-ECMO group had subtherapeutic concentrations (<2 mg/L).…”

Section: Sedation and Analgesiamentioning

confidence: 98%

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

Dzierba

Muir

Dilawri

et al. 2023

J Am Coll Clin Pharm

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Extracorporeal membrane oxygenation (ECMO) is a complex therapy aimed at providing mechanical support for patients with severe, life-threating cardiac and/or respiratory failure. Research has demonstrated variability in pharmacokinetic changes in the critically ill patient population receiving ECMO. There is a need to understand the complexity of these pharmacokinetic changes to provide optimal pharmacotherapeutic regimens thereby maximizing effectiveness and mitigating harm. However, the number of pharmacokinetic studies in patients receiving ECMO remains small, and very few prospective studies have been published addressing optimal analgesic, sedative, or antimicrobial therapy. Anticoagulation is an additional important component of ECMO therapy but the preferred agent as well as dosing and monitoring strategy are unclear. The purpose of this narrative review is to discuss analgesia and sedation, antimicrobial, and anticoagulation management strategies in adult patients receiving ECMO.

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Section: Antimicrobialsmentioning

confidence: 98%

Section: Sedation and Analgesiamentioning

confidence: 98%

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

Dzierba

Muir

Dilawri

et al. 2023

J Am Coll Clin Pharm

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“…Common adverse effects include liver toxicity and QT-prolongation (except with isavuconazole), and they all exhibit to different degrees drug–drug interactions via the cytochrome P450 enzyme system and/or P-glycoprotein transporters. Fluconazole [ 41 , 42 ], isavuconazole [ 43 , 44 ], posaconazole [ 45 ] and voriconazole [ 46 , 47 ] PK have been studied in critically ill patients on ECMO support.…”

Section: Specific Antifungal Classesmentioning

confidence: 99%

“…Dhanani et al reported the PK of IV fluconazole in an adult patient on VV ECMO. At the administered dose of fluconazole 6 mg/kg daily, the trough concentration and AUC 0–24 met the PK/PD target for prophylaxis despite the 40% increase in V d observed compared with critically ill adults not on ECMO [ 41 ].…”

Section: Specific Antifungal Classesmentioning

confidence: 99%

Antifungal Dosing in Critically Ill Patients on Extracorporeal Membrane Oxygenation

et al. 2023

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Extracorporeal membrane oxygenation (ECMO) is an established advanced life support system, providing temporary cardiac and/or respiratory support in critically ill patients. Fungal infections are associated with increased mortality in patients on ECMO. Antifungal drug dosing for critically ill patients is highly challenging because of altered pharmacokinetics (PK). PK changes during critical illness; in particular, the drug volume of distribution ( V d ) and clearance can be exacerbated by ECMO. This article discusses the available literature to inform adequate dosing of antifungals in this patient population. The number of antifungal PK studies in critically ill patients on ECMO is growing; currently available literature consists of case reports and studies with small sample sizes providing inconsistent findings, with scant or no data for some antifungals. Current data are insufficient to provide definitive empirical drug dosing guidance and use of dosing strategies derived from critically patients not on ECMO is reasonable. However, due to high PK variability, therapeutic drug monitoring should be considered where available in critically ill patients receiving ECMO to prevent subtherapeutic or toxic antifungal exposures. Supplementary Information The online version contains supplementary material available at 10.1007/s40262-023-01264-0.

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The impact of extracorporeal membrane oxygenation on antifungal pharmacokinetics: A systematic review

Jendoubi,

Pressiat,

De Roux

et al. 2024

International Journal of Antimicrobial Agents

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Pharmacokinetics of fluconazole and ganciclovir as combination antimicrobial chemotherapy on ECMO: a case report

Cited by 7 publications

References 11 publications

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

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

Antifungal Dosing in Critically Ill Patients on Extracorporeal Membrane Oxygenation

The impact of extracorporeal membrane oxygenation on antifungal pharmacokinetics: A systematic review

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