A. Cotera et al., PHARMACOKINETICS AND CLEARANCE OF CIPROFL OXACIN AND AMIKACIN DURING CONTINUOUS HEMODIALYSIS, Revista Medica de Chile, 123(6), 1995, pp. 742-748
We studied the pharmacokinetic and clearance of a 200 mg ciprofloxacin
and a 500 mg amikacin intravenous dose during 5 continuous hemodialys
es procedures in 5 patients with acute oliguric renal failure. Hourly
blood and ultrafiltrate drug concentrations were measured during 8 hou
rs. Dialysate flux (Qd) was 16.6 ml/min during the first hours and 33.
2 ml/mn thereafter. For each Qd, total ciprofloxacin clearance was 1.1
3+/-0.99 and 2.8+/-1.71 ml/min (p<0.0001), diffusive clearance was 0.9
6+/-0.87 and 2.47+/-1.56 ml/min (p<0.005) and convective clearance was
0.16+/-0.17 and 0.33+/-0.2 ml/min (p<0.05). Likewise, total amikacin
clearance was 3.47+/-1.31 and 4.18+/-0.53 ml/min (p<0.001), diffusive
clearance was 2.97+/-1.24 and 3.86+/-0.52 ml/min and convective cleara
nce was 0.50+/-0.47 and 0.32+/-0.29 ml/min (p=NS). Protein binding was
84% for ciprofloxacin and 77% for amikacin. It is concluded that duri
ng continuous hemodialysis with cuprofan membrane, the main transport
mechanism of ciprofloxacin and amikacin is diffusive. Very low amounts
of ciprofloxacin are depurated by the dialyser. Likewise, the shorten
ing of amikacin half life suggests the presence of other elimination p
ahway and the need to use supplementary doses every 24 hours.