Pharmacokinetics of colistin during extracorporeal membrane oxygenation



Year of publication 2022
Type Article in Periodical
Magazine / Source Journal of Antimicrobial Chemotherapy
MU Faculty or unit

Faculty of Medicine

Keywords Pharmacokinetics of colistin; extracorporeal membrane oxygenation
Attached files
Description During the recent COVID-19 pandemic, several patients required extracorporeal membrane oxygenation (ECMO) due to COVID-19 infection complicated by ventilator-associated pneumonia caused by MDR Pseudomonas aeruginosa that was only susceptible to colistin. Extracorporeal circuits, in general, represent another compartment that increases the volume of distribution for hydrophilic compounds and may affect drug clearance.1 Besides that, ECMO can, more importantly, influence pharmacokinetics by drug adsorption on the circuit surface. This phenomenon is influenced by physicochemical properties of the medication – mainly lipophilicity and protein binding – but it is also dependent on particular materials of circuit components and circuit coating. Since both colistin and its prodrug colistin methanesulfonate (CMS) are hydrophilic substances (logP -2.4 for colistin) with medium protein binding (approx. 50% for colistin), adsorption on the ECMO circuit seems unlikely. We have not found any data on potential adsorption on an ECMO circuit; however, adsorption on the polysulphone membrane dialyser was described.2 Therefore, we were concerned about the reduced plasma levels and disturbed effectiveness of colistin therapy in our patients.

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