Exploring dosing of anti-MRSA antibiotics for patients undergoing prolonged hemodiafiltration: a single-center retrospective study

Background: Prolonged hemodiafiltration (HDF) is a blood purification therapy used for fulminant hepatitis to improve impaired consciousness, hemodynamics, hyperammonemia, and renal function. Methicillin-resistant Staphylococcus aureus (MRSA) infections, including sepsis and fulminant hepatitis, are routinely treated with antibiotics. However, no studies have investigated the effects of prolonged HDF on the pharmacokinetics of the anti-MRSA antibiotics teicoplanin and vancomycin. We performed an exploratory assessment of optimal dosing of these drugs in critically ill patients undergoing prolonged HDF. Methods: In this single-center retrospective study, we enrolled patients who underwent therapeutic drug monitoring after the administration of a maintenance dose of teicoplanin or vancomycin during prolonged HDF. Patients treated with teicoplanin were categorized into albumin (ALB) administration, plasma exchange (PE), and normal administration groups. The pharmacokinetics of vancomycin were relatively unaffected by serum ALB levels; therefore, patients treated with vancomycin were categorized into PE and normal administration groups. Dialysis prescription parameters were recorded for each patient. These parameters are summarized alongside the maintenance doses and trough concentrations of anti-MRSA antibiotics in a table 7. Results: During prolonged HDF, the dialysis flow rate was 30,000 mL/h (interquartile range [IQR], 30,000–30,000), and the hemofiltration ratio was 2000 mL/h (IQR 2000–2500). In the normal administration group, the median maintenance dose of teicoplanin was 10.4 mg/kg/day (IQR 6.5–13.3), and the trough concentration was 17.4 μg/mL (IQR 15.9–17.8). In the ALB and PE groups, the median maintenance of teicoplanin dose was 9.4 mg/kg/day (IQR 7.8–9.9), and the trough concentration was 9.2 μg/mL (IQR 8.1–10.9). The median maintenance dose of vancomycin in the normal administration group was 40.7 mg/kg/day (IQR 25.4–45.7), and the trough concentration was 10.2 μg/mL (IQR 9.5–10.4). In the PE group, the maintenance dose of vancomycin was 23.0 mg/kg/day, and the trough concentration was 4.43 μg/mL. Conclusions: The findings of this study suggest that when administering teicoplanin and vancomycin to patients undergoing prolonged HDF, their maintenance dosages may need to be adjusted not only according to dialysis prescription parameters, but also in consideration of the patient’s general condition and concomitant therapies such as plasma exchange or albumin administration.