Pharmacokinetics of antifungal agent micafungin in critically ill patients receiving continuous hemodialysis filtration

Currently in Japan, the preferred method for blood purification in patients with acute renal failure is continuous hemodiafiltration (CHDF). However, CHDF filters out various antifungal drugs such as fluconazole through large pores in the membrane used. Systemic fungal infection is still one of the main causes of death and complications in critically ill patients in intensive care units (ICUs). Therefore it is important to determine the appropriate use of antifungal agents. This study was designed to evaluate the influence of CHDF on the pharmaco kinetics of the antifungal agent micafungin in ICU patients. The pharmaco kinetics of micafungin were studied in four ICU patients receiving CHDF and in nine ICU patients not receiving CHDF. To evaluate the pharmacokinetics, the ratio of serum micafungin concentration to dose per body weight (C/D) was used in this study. There was no progressive accumulation or exclusion of micafungin in patients receiving CHDF. The mean ( S.D.) extraction rate (%) for micafungin during CHDF was 3.6 +/- 3.9. There was no significant difference in the serum micafungin C/D-time profiles between the patients receiving and not receiving CHDF. These results show that CHDF does not affect the pharmaco kinetics of micafungin. Therefore it is not necessary to adjust the micafungin dose in patients receiving CHDF.