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NDT Advance Access originally published online on February 18, 2009
Nephrology Dialysis Transplantation 2009 24(7):2283-2285; doi:10.1093/ndt/gfp060
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© The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Risk of underdosing of ampicillin/sulbactam in patients with acute kidney injury undergoing extended daily dialysis—a single case

Jan T. Kielstein1, Johan Lorenzen1, Volkhard Kaever2, Heike Burhenne2, Michael Broll1, Carsten Hafer1 and Olaf Burkhardt3

1 Division of Nephrology and Hypertension, Department of Internal Medicine, Medical School Hannover 2 Institute for Pharmacology, Medical School Hannover 3 Division of Pulmonary Medicine, Department of Internal Medicine, Medical School Hannover, Hannover, Germany

Correspondence and offprint requests to: Jan T. Kielstein; E-mail: Kielstein{at}yahoo.com



  Abstract

The fixed antibacterial combination of ampicillin and sulbactam is frequently used for various infections. The normal kidneys eliminate ~60% of ampicillin (371.39 Da) and sulbactam (255.22 Da). Concomitant with the decline in renal function, the terminal elimination half-life increases from 1 up to 24 h in patients with ESRD. Patients on three times weekly low flux haemodialysis exhibit a half-life of 2.3 h on and 17.4 h off dialysis. In contrast, in the present observation the elimination half-life in a single patient with acute kidney injury undergoing extended daily dialysis (EDD) with a polysulphone membrane was 1.5 h, indicating that the current dosing regimen for haemodialysis outpatients (ampicillin/sulbactam 2.0/1.0 g/day) would result in a significant underdosing for patients undergoing EDD.

Keywords: beta-lactamase inhibitor; dialysis; Genius-dialysis; pharmacokinetics

Received for publication: 14. 1.09
Accepted in revised form: 27. 1.09


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