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Pharmacokinetics of Sulfamethoxazole and Trimethoprim During Venovenous Extracorporeal Membrane Oxygenation: A Case Report.

Authors
  • Dhanani, Jayesh A1, 2, 3
  • Lipman, Jeffrey1, 3
  • Pincus, Jason3, 4
  • Townsend, Shane3, 4
  • Livermore, Amelia3
  • Wallis, Steven C1
  • Pandey, Saurabh5
  • Abdul-Aziz, Mohd H1
  • Roberts, Jason A1, 3, 6, 7, 8
  • 1 Faculty of Medicine, University of Queensland Centre of Clinical Research, The University of Queensland, Brisbane, Queensland, Australia. , (Australia)
  • 2 School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia. , (Australia)
  • 3 Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia. , (Australia)
  • 4 School of Medicine, University of Queensland, Herston, Queensland, Australia. , (Australia)
  • 5 University Of Queensland Centre for Clinical Research, University of Queensland, Herston, Queensland, Australia. , (Australia)
  • 6 Department of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia. , (Australia)
  • 7 Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia. , (Australia)
  • 8 Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France. , (France)
Type
Published Article
Journal
Pharmacotherapy
Publication Date
Jul 01, 2020
Volume
40
Issue
7
Pages
713–717
Identifiers
DOI: 10.1002/phar.2413
PMID: 32378219
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Extracorporeal membrane oxygenation (ECMO) therapy could affect drug concentrations via adsorption onto the oxygenator and/or associated circuit. We describe a case of a 33-year-old man with severe respiratory failure due to Pneumocystis jirovecii infection on a background of recently diagnosed human immunodeficiency virus infection. He required venovenous ECMO therapy for refractory respiratory failure. Intravenous sulfamethoxazole-trimethoprim (100 and 20 mg/kg/day) was administered in a dosing regimen every 6 hours. Pre-oxygenator, post-oxygenator, and arterial blood samples were collected after antibiotic administration and were analyzed for total sulfamethoxazole and trimethoprim concentrations. The peak sulfamethoxazole and trimethoprim concentrations were 122 mg/L and 5.3 mg/L, respectively. The volume of distribution for sulfamethoxazole was 0.37 and 2.30 L/kg for trimethoprim. The clearance for sulfamethoxazole was 0.35 ml/minute/kg and for trimethoprim was 1.64 ml/minute/kg. The pharmacokinetics of sulfamethoxazole and trimethoprim appear not to be affected by ECMO therapy, and dosing adjustment may not be required. © 2020 Pharmacotherapy Publications, Inc.

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