Can physicochemical properties of antimicrobials be used to predict their pharmacokinetics during extracorporeal membrane oxygenation? Illustrative data from ovine models

Kiran Shekar; Jason A Roberts; Adrian G Barnett; Sara Diab; Steven C Wallis; Yoke Lin Fung; John F Fraser

doi:10.1186/s13054-015-1151-y

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Can physicochemical properties of antimicrobials be used to predict their pharmacokinetics during extracorporeal membrane oxygenation? Illustrative data from ovine models

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Can physicochemical properties of antimicrobials be used to predict their pharmacokinetics during extracorporeal membrane oxygenation? Illustrative data from ovine models

Kiran Shekar, Jason A Roberts, Adrian G Barnett, Sara Diab, Steven C Wallis, Yoke Lin Fung and John F Fraser

Critical Care, Vol.19, 437

2015

DOI: https://doi.org/10.1186/s13054-015-1151-y

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Abstract

Introduction: Ex vivo experiments in extracorporeal membrane oxygenation (ECMO) circuits have identified octanol-water partition coefficient (logP, a marker of lipophilicity) and protein binding (PB) as key drug factors affecting pharmacokinetics (PK) during ECMO. Using ovine models, in this study we investigated whether these drug properties can be used to predict PK alterations of antimicrobial drugs during ECMO. Methods Single-dose PK sampling was performed in healthy sheep (HS, n= 7), healthy sheep on ECMO (E24H, n= 7) and sheep with smoke inhalation acute lung injury on ECMO (SE24H, n= 6). The sheep received eight study antimicrobials (ceftriaxone, gentamicin, meropenem, vancomycin, doripenem, ciprofloxacin, fluconazole, caspofungin) that exhibit varying degrees of logP and PB. Plasma drug concentrations were determined using validated chromatographic techniques. PK data obtained from a non-compartmental analysis were used in a linear regression model to predict PK parameters based on logP and PB. Results We found statistically significant differences in pH, haemodynamics, fluid balance and plasma proteins between the E24H and SE24H groups (p < 0.001). logP had a strong positive linear relationship with steady-state volume of distribution (Vss) in both the E24H and SE24H groups (p < 0.001) but not in the HS group (p = 0.9) and no relationship with clearance (CL) in all study groups. Although we observed an increase in CL for highly PB drugs in ECMO sheep, PB exhibited a weaker negative linear relationship with both CL (HS, p = 0.01; E24H, p < 0.001; SE24H, p < 0.001) and Vss (HS, p = 0.01; E24H, p = 0.004; SE24H, p =0.05) in the final model. Conclusions Lipophilic antimicrobials are likely to have an increased Vss and decreased CL during ECMO. Protein-bound antimicrobial agents are likely to have reductions both in CL and Vss during ECMO. The strong relationship between lipophilicity and Vss seen in both the E24H and SE24H groups indicates circuit sequestration of lipophilic drugs. These findings highlight the importance of drug factors in predicting antimicrobial drug PK during ECMO and should be a consideration when performing and interpreting population PK studies.

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Title: Can physicochemical properties of antimicrobials be used to predict their pharmacokinetics during extracorporeal membrane oxygenation? Illustrative data from ovine models
Authors: Kiran Shekar (Author) - University of Queensland
Jason A Roberts (Author) - University of Queensland
Adrian G Barnett (Author) - Queensland University of Technology
Sara Diab (Author) - University of Queensland
Steven C Wallis (Author) - University of Queensland
Yoke Lin Fung (Author) - University of the Sunshine Coast - Faculty of Science, Health, Education and Engineering
John F Fraser (Author) - University of Queensland
Publication details: Critical Care, Vol.19, 437; 11
Publisher: BioMed Central Ltd.
Date published: 2015
DOI: 10.1186/s13054-015-1151-y
ISSN: 1364-8535
Copyright note: Copyright © 2015 Shekar et al. Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Organisation Unit: School of Health - Biomedicine; University of the Sunshine Coast, Queensland; School of Health and Sport Sciences - Legacy; School of Health and Behavioural Sciences - Legacy
Language: English
Record Identifier: 99449602202621
Output Type: Journal article

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