Article: Sub-therapeutic trimethoprim and sulfamethoxazole plasma concentrations during continuous venovenous hemofiltration in a patient with COVID-19 and pulmonary
International journal of clinical pharmacology and therapeutics
2023 Volume 61, Issue 11, Page(s) 525–530
Abstract: Objective: To investigate drug concentration of trimethoprim-sulfamethoxazole (TMP-SMX) using therapeutic drug monitoring (TDM) for severe : Materials and methods: A 72-year-old man with hypoxemic respiratory failure due to COVID-19 infection was ... ...
Abstract | Objective: To investigate drug concentration of trimethoprim-sulfamethoxazole (TMP-SMX) using therapeutic drug monitoring (TDM) for severe Materials and methods: A 72-year-old man with hypoxemic respiratory failure due to COVID-19 infection was admitted to the intensive care unit for invasive mechanical ventilation. The patient developed acute renal failure that required RCA-CVVH. Pulmonary co-infection with PJP was diagnosed, and a high TMP-SMX dose was initiated according to (inter)national guidelines with dose reduction after 3 days because of renal failure. Population pharmacokinetics were assessed for TMP and SMX as well as clearance by RCA-CVVH, volume of distribution, and time above threshold levels for measured plasma concentrations. Results: During renal failure requiring RCA-CVVH, a corresponding dose reduction of TMP-SMX to 320/1,600 mg twice a day, according to current Dutch SWAB and Dutch Association of Hospital Pharmacists guidelines, resulted in unintended under-dosing with sub-therapeutic TMP-SMX concentrations. Pharmacokinetic modeling and dose adjustment of TMP-SMX to 640/3,200 mg 3 times daily resulted in steady-state TMP-SMX peak concentrations associated with efficacy against PJP. Hence, the patient was successfully weaned from the ventilator and discharged. Conclusion: We hypothesize that our new dose recommendation of 640/3,200 mg TMP-SMX 3 times daily is associated with an increased probability of critical patients being successfully liberated from mechanical weaning following PJP pneumonia and COVID-19 infection. |
---|---|
MeSH term(s) | Male ; Humans ; Aged ; Trimethoprim, Sulfamethoxazole Drug Combination ; Pneumocystis carinii ; Pneumonia, Pneumocystis/complications ; Pneumonia, Pneumocystis/diagnosis ; Pneumonia, Pneumocystis/drug therapy ; Continuous Renal Replacement Therapy ; Coinfection/drug therapy ; COVID-19/complications ; COVID-19/therapy ; Renal Insufficiency ; Retrospective Studies |
Chemical Substances | Trimethoprim, Sulfamethoxazole Drug Combination (8064-90-2) |
Language | English |
Publishing date | 2023-07-24 |
Publishing country | Germany |
Document type | Case Reports ; Journal Article |
ZDB-ID | 124384-6 |
ISSN | 0946-1965 ; 0340-0026 ; 0300-9718 ; 0174-4879 |
ISSN | 0946-1965 ; 0340-0026 ; 0300-9718 ; 0174-4879 |
DOI | 10.5414/CP204407 |
Database | MEDical Literature Analysis and Retrieval System OnLINE |
More links
Kategorien
In stock of ZB MED Cologne/Königswinter
Zs.A 467: Show issues | Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG) |
Order via subito
This service is chargeable due to the Delivery terms set by subito. Orders including an article and supplementary material will be classified as separate orders. In these cases, fees will be demanded for each order.