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

Purpose Adequate dosing of antimicrobials is critical to properly treat infections and limit development of resistance and adverse effects. Limited guidance exists for antimicrobial dosing adjustments in patients requiring extracorporporeal membrane oxygenation (ECMO) therapy. A systematic review was conducted to delineate the pharmacokinetics (PK) and pharmacodynamics (PD) of antimicrobials in critically ill adult patients requiring ECMO. Methods Medline, EMBASE, Global Health, and All EBM Reviews databases were searched. Grey literature was examined. All studies reporting PK/PD parameters of antimicrobials in critically ill adults treated with ECMO were included, except for case reports and congress abstracts. Ex vivo studies were included. Two independent reviewers applied the inclusion and exclusion criteria. Reviewers were then paired to independently abstract data and evaluate methodological quality of studies using the ROBINS-I tool and the compliance with ClinPK guidelines. Patients’ and studies’ characteristics, key PK/PD findings, details of ECMO circuits and co-treatments were summarized qualitatively. Dosing recommendations were formulated based on data from controlled studies. Results Thirty-two clinical studies were included; most were observational and uncontrolled. Fourteen ex vivo studies were analysed. Information on patient characteristics and co-treatments was often missing. The effect of ECMO on PK/PD parameters of antimicrobials varied depending on the studied drugs. Few dosing recommendations could be formulated given the lack of good quality data. Conclusion Limited data exist on the PK/PD of antimicrobials during ECMO therapy. Rigorously designed and well powered populational PK studies are required to establish empiric dosing guidelines for antimicrobials in patients requiring ECMO support. PROSPERO Registration Number CRD42018099992 (Registered: July 24th 2018)..

Medienart:

E-Artikel

Erscheinungsjahr:

2021

Erschienen:

2021

Enthalten in:

Zur Gesamtaufnahme - volume:81

Enthalten in:

Drugs - 81(2021), 11 vom: Juli, Seite 1307-1329

Sprache:

Englisch

Beteiligte Personen:

Duceppe, Marc-Alexandre [VerfasserIn]
Kanji, Salmaan [VerfasserIn]
Do, Anh Thu [VerfasserIn]
Ruo, Ni [VerfasserIn]
Cavayas, Yiorgos Alexandros [VerfasserIn]
Albert, Martin [VerfasserIn]
Robert-Halabi, Maxime [VerfasserIn]
Zavalkoff, Samara [VerfasserIn]
Dupont, Patrice [VerfasserIn]
Samoukovic, Gordan [VerfasserIn]
Williamson, David R. [VerfasserIn]

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BKL:

44.40

44.38

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© The Author(s), under exclusive licence to Springer Nature Switzerland AG 2021

doi:

10.1007/s40265-021-01557-3

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

SPR044690738