Altered antibiotic pharmacokinetics during extracorporeal membrane oxygenation: cause for concern?

Extracorporeal membrane oxygenation (ECMO) is a supportive therapy and definitive management often relies on adequate drug therapy aimed at reversing the underlying cause of cardiac and/or respiratory failure. Despite this, a paucity of data exists describing the impact of ECMO on pharmacokinetics (PK) and antibiotic dosing requirements. By default, clinicians prescribe standard doses to these complicated patients, thereby risking therapeutic failure or toxicity. We report two patients to highlight our concerns with regard to antibiotic therapy in the presence of ECMO. Ethics approval was granted by the local Human Research Ethics Committee (HREC/11/QPCH/121).