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JAC Advance Access published online on September 3, 2004
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkh421
© 2004 by The British Society for Antimicrobial Chemotherapy
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Received April 15, 2004
Revised July 20, 2004
Accepted August 6, 2004

Original article

Pharmacokinetics of moxifloxacin in patients undergoing continuous venovenous haemodiafiltration

Valentin Fuhrmann 1*, Peter Schenk 1, Walter Jaeger 2, Salwa Ahmed 2, and Florian Thalhammer 3

1 Department of Internal Medicine 4, Intensive Care Unit, University Hospital Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
2 Pharmacy Centre, Institute of Pharmaceutical Chemistry, University of Vienna, Vienna, Austria
3 Department of Internal Medicine 1, Division of Infectious Diseases, University Hospital Vienna, Vienna, Austria

* To whom correspondence should be addressed. E-mail: valentin.fuhrmann{at}akhwien.at.


  Abstract

Objective: Moxifloxacin is an 8-methoxy quinolone with a broad range of activity against clinically important pathogens. Therefore it is frequently administered in severe respiratory tract infections. Continuous venovenous haemodiafiltration (CVVHDF) is an important extracorporeal renal replacement therapy for intensive care patients suffering from sepsis and multiple organ failure. The aim of this study was to investigate the pharmacokinetics of intravenous moxifloxacin in anuric critically ill patients undergoing CVVHDF.

Patients and methods: Pharmacokinetic analysis was performed in nine intensive care patients with acute renal failure and suspected or proven infection sensitive to moxifloxacin, who received moxifloxacin 400 mg intravenously once daily. The concentration of moxifloxacin in serum and ultradiafiltrate was determined by HPLC.

Results: Peak and trough serum concentrations were 3.76±2.02 mg/L and 0.24±0.14 mg/L, respectively, at the arterial port after the first dose. The mean elimination half-life was 9.87±3.26 h, the volume of distribution 270±133 L and the calculated AUC0-24 18.41±8.46 mg·h/L. Total clearance was 19.09±8.22 L/h and the clearance of haemodiafiltration 1.63±0.33 L/h.

Conclusions: The pharmacokinetics of moxifloxacin in critically ill patients with acute renal failure undergoing CVVHDF was comparable to healthy subjects and patients without renal impairment. We recommend 400 mg of intravenous moxifloxacin once per day in anuric patients during CVVHDF.

Keywords: antibiotics; dosage recommendations; renal failure; renal replacement therapy; intensive care patients.

The study was performed at the Department of Internal Medicine 4, Intensive Care Unit, University Hospital Vienna, Austria


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