PHARMACOKINETICS OF ANTIMICROBIAL AGENTS IN CONTINUOUS HEMOFILTRATION

New assist techniques: Continuous hemofiltration and hemodiafiltration are two new renal replacement techniques offering continuous electrol yte regulation and hemodynamic stability in patients with multiple org an failure. These continuous techniques are being used more and more i n intensive care, especially as renal replacement in case of septic sh ock, and probably have the additional benefit of removing toxins. Effe ct on antimicrobials: Little is known about the removal of drugs and i n particular antimicrobials during continuous hemofiltration although both the specific pharmacokinetics oi each drug and the patient's part icular clinical situation plays an important role. Drug dosing: In the intensive care unit, knowledge of the effect of continuous hemofiltra tion on drug removal and pharmacokinetic profile is crucial for practi cal management due to the importance of avoiding infratherapeutic seru m levels, or inversely toxic levels, in these seriously ill patients. Titration equations provided in most of the recent articles are helpfu l but usually based on a large number of parameters not always easily available in clinical practice. An approximation of the appropriate do se can be estimated from dosing guides for continuous dialysis which c an be useful in avoiding poorly adapted dosage.