Abstract | OBJECTIVE: DESIGN: Measurements of serum and ultrafiltrate (UF) concentrations and in vitro sensitivity testing of isolated micro-organisms. SETTING: University hospital-based, single ICU. PATIENTS: INTERVENTIONS:
Cefpirome i.v. was started at 2 g in 30 min, then continued 1 g i.v.b.i.d. MEASUREMENTS: The UF rate was 27 +/- 7 ml/min on day 1 and 34 +/- 2 ml/min on day 2. Serum and ultrafiltrate samples were measured by a validated high performance liquid chromatography assay. Volume of distribution: 23 x 5(SD +/- 4 x 6) l. Total cefpirome clearance was 32 +/- 6 x 3 ml/min; cefpirome CVVH clearance (ClCVVH): 17 +/- 4.2 ml/min; mean serum half-life (t1/2): 8.8 +/- 2.3 h; mass transfer on day 1: 660 +/- 123 mg/12 h (33 +/- 6% of administered dose) and day 2: 642 +/- 66 mg/12 h (64 +/- 7%). Estimated sieving coefficient (ClCVVH/UF rate): 64 +/- 11%. In vitro sensitivity of isolated microbes was excellent except for two non-sensitive enterococci and Candida spp. CONCLUSIONS: The sieving coefficient (64%) indicates that a substantial fraction of the drug is not filtered; clearance by pathways other than CVVH mounted to 50% of the total clearance and increased on day 2, indicating that the dosing schedule used is appropriate for this setting. Cefpirome appeared to be safe in these patients and effective for most of the nosocomial microbial isolates. During more than 90% of the time, serum levels were maintained above killing concentrations for susceptible micro-organisms.
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Authors | T S Van der Werf, J W Fijen, N C Van de Merbel, R Spanjersberg, A V Möller, J J Ligtenberg, J E Tulleken, J G Zijlstra, C A Stegeman |
Journal | Intensive care medicine
(Intensive Care Med)
Vol. 25
Issue 12
Pg. 1427-31
(Dec 1999)
ISSN: 0342-4642 [Print] United States |
PMID | 10660852
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
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Topics |
- APACHE
- Aged
- Cephalosporins
(administration & dosage, pharmacokinetics)
- Critical Care
- Female
- Hemofiltration
- Humans
- Infusions, Intravenous
- Male
- Middle Aged
- Multiple Organ Failure
(complications)
- Renal Insufficiency
(complications, metabolism, therapy)
- Sepsis
(blood, complications, drug therapy)
- Serum Bactericidal Test
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