Antibiotic dosing during extracorporeal membrane oxygenation: does the system matter?

Area of Science:

• Critical Care Medicine
• Pharmacology
• Infectious Diseases

Background:

• Critically ill adult patients on extracorporeal membrane oxygenation (ECMO) present unique challenges for antibiotic therapy.
• Understanding drug disposition in this population is vital for effective treatment of infections.

Purpose of the Study:

• To review the impact of ECMO on antibiotic pharmacokinetics.
• To discuss how these changes influence antibiotic dosing requirements in adult ECMO patients.

Main Methods:

• Literature review of studies examining antibiotic pharmacokinetics and dosing in adult ECMO patients.
• Analysis of emerging clinical pharmacokinetic data.

Main Results:

• Limited literature exists, but recent data highlight key considerations for antibiotic dosing.
• Antibiotic properties influence drug loss in the ECMO circuit; neonatal/pediatric data are not directly applicable to adults.
• Modern ECMO circuits have minimal impact; pharmacokinetic changes are mainly due to critical illness itself.

Conclusions:

• Optimizing antibiotic dosing in ECMO patients requires understanding pharmacokinetic alterations.
• Dosing strategies should generally align with those for critically ill patients not on ECMO.
• Therapeutic drug monitoring (TDM) is valuable for guiding antibiotic doses.