gms | German Medical Science

Bacterial infections are one of the most important clinical problems and contribute to the high mortality rate in patients with decompensated liver cirrhosis. Fluoroquinolones are highly effective drugs and are frequently used in patients with cirrhosis of the liver, especially for prophylaxis of spontaneous bacterial peritonitis. However, pharmacokinetic data on fluoroquinolones for these patients are sparse and conflicting. Albumin dialysis by Molecular Adsorbent Recirculating System (MARS) is an extracorporeal detoxification method with growing clinical acceptance for the therapy of patients with acute or acute on chronic liver failure. Already it was demonstrated by our group, that in-vitro experiments on drug elimination also less albumin bound substances like levofloxacin (bound fraction 24–52%) are eliminated by MARS to a higher extend compared to conventional dialysis. The aim of this clinical investigation was to determine the pharmacokinetics of ciprofloxacin and levofloxacin in patients with end-stage liver disease during albumin dialysis. During 11 clinical MARS treatments the elimination of ciprofloxacin (n=6) and levofloxacin (n=5) was evaluated. Elimination was found to be decreased in patients with decompensated chronic liver disease (Child C). Although during the entire MARS treatment period both fluoroquinolones were removed to a significant degree, no negative impact on antimicrobiological therapy could be assumed with respect to PK/PD relationship. The results suggest that the impaired endogenous clearance in liver failure might be compensated in part by increased extracorporeal clearance during MARS treatments. Therefore we conclude that no dosage adjustment of ciprofloxacin and levofloxacin seems to be necessary for patients with severe end stage liver disease during albumin dialysis treatments. Due to the individual variability of pharmacokinetics in patients with severe liver failure antimicrobial therapy with fluoroquinolones should be accompanied by a careful observation of the patients (to provide for clinical efficacy and to detect adverse side effects) and, if available, by therapeutic drug monitoring.