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Elimination of flucytosine by continuous hemofiltration
1College of Pharmacy, University of Illinois at Chicago 60612, USA.
American Journal of Nephrology
|January 1, 1995
Summary
Continuous hemofiltration effectively removes flucytosine, an antifungal drug, in patients with acute renal failure. Optimal dosage adjustments are crucial, considering drug levels and hemofiltration parameters.
Area of Science:
- Pharmacology
- Nephrology
- Infectious Diseases
Background:
- Flucytosine is a critical antifungal agent for severe infections.
- Acute renal failure may necessitate continuous hemofiltration (CHF) for renal replacement therapy.
- The impact of CHF on flucytosine levels in patients with renal impairment is not well-defined.
Observation:
- This study assessed flucytosine removal during CHF in a patient with systemic Candida infection and acute renal failure.
- Drug concentrations in arterial, venous, and ultrafiltrate samples were analyzed.
- Different hemofilter membranes (polysulfone and polyacrylonitrile) were evaluated for their efficacy in removing flucytosine.
Findings:
- Both polysulfone and polyacrylonitrile membranes removed flucytosine, with higher removal rates observed with the polysulfone membrane.
- Flucytosine removal varied from 2.54 to 22.56 mg/hour, depending on serum drug concentrations (21.1-126.5 mg/l).
- Clearance rates were significantly higher for the polysulfone membrane (77.0%) compared to the polyacrylonitrile membrane (51.0%) relative to the ultrafiltrate flow rate.
Implications:
- Continuous hemofiltration can significantly reduce flucytosine levels in patients with renal failure.
- The type of hemofilter membrane and ultrafiltration rate influence the extent of drug removal.
- Therapeutic drug monitoring and dose adjustments are essential to maintain effective flucytosine concentrations during CHF.