Pharmacokinetic profile of acyclovir in a child receiving continuous kidney replacement therapy for acute liver failure.
- Resource Type
- Academic Journal
- Authors
- Collignon C; Pediatric Intensive Care Unit, APHP University Hospital Necker-Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France. charlotte.collignon@aphp.fr.; de Marcellus C; Pediatric Intensive Care Unit, APHP University Hospital Necker-Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France.; Oualha M; Pediatric Intensive Care Unit, APHP University Hospital Necker-Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France.; Université de Paris, Paris, France.; Neuranter V; Pharmacology and Drug Evaluation in Children and Pregnant Women EA7323, Paris Descartes University, Paris, France.; Department of Clinical Pharmacology, Cochin Hospital, Paris, France.; Heilbronner C; Pediatric Intensive Care Unit, APHP University Hospital Necker-Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France.; Hirt D; Université de Paris, Paris, France.; Pharmacology and Drug Evaluation in Children and Pregnant Women EA7323, Paris Descartes University, Paris, France.; Department of Clinical Pharmacology, Cochin Hospital, Paris, France.
- Source
- Publisher: Springer International Country of Publication: Germany NLM ID: 8708728 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-198X (Electronic) Linking ISSN: 0931041X NLM ISO Abbreviation: Pediatr Nephrol Subsets: MEDLINE
- Subject
- Language
- English
Background: Continuous venovenous hemodiafiltration (CVVHDF) is one of the treatments of critically ill children presenting severe acute liver failure. This affliction might be induced by HSV infection requiring a treatment by acyclovir. Continuous kidney replacement therapy (CKRT) can alter its pharmacokinetics, according to its physicochemical properties and CVVHDF settings.
Case-Diagnosis/treatment: The patient was a 21-month-old female presenting liver failure with hyperammonemia treated by acyclovir with presumed HSV infection. CKRT was initiated on day 1 with substantial replacement and dialysate flow rates (respectively 75 and 220 mL/kg/h). Acyclovir was intravenously administered every 8 h with a 1-h infusion of 500 mg/m 2 . Plasma and effluent concentrations were measured by liquid chromatography-tandem mass spectrometry assay to estimate the area under a curve (AUC) and CKRT clearance by 2 methods (one based on pre- and post-filter concentrations and the other one on dialysate flow rates). Clearance was estimated between 19.2 and 26.3 mL/min with the first method and between 27.6 and 44.3 mL/min with the second one. Concentrations were highly above the therapeutic index (peak concentration was measured at 28 mg/L), but AUC was appropriate.
Conclusions: This case describes acyclovir pharmacokinetics during CKRT in a pediatric patient treated by acyclovir. The patient was treated with adapted exposure with the usual dosing, but lower dosing should be investigated with complementary studies.
Trial Registration: ClinicalTrials.gov NCT02539407.
(© 2023. The Author(s), under exclusive licence to International Pediatric Nephrology Association.)