Ajuste de dosis de antimicrobianos en pacientes con Oxigenación por Membrana Extracorpórea

José Pablo Díaz Madriz
Departamento de Farmacia Clínica, Hospital Clínica Bíblica, San José, Costa Rica.

Gustavo Ortega Oviedo
Facultad de Farmacia, Universidad de Ciencias Médicas, San José, Costa Rica.

César Barrantes Murillo
Facultad de Farmacia, Universidad de Ciencias Médicas, San José, Costa Rica.

Sebastián Arguedas Chacón
Departamento de Investigación, Hospital Clínica Bíblica, San José, Costa Rica.

Resumen

La oxigenación por membrana extracorpórea (ECMO) es una modalidad de soporte vital utilizada en pacientes con insuficiencia cardiopulmonar grave, asociada a alteraciones farmacocinéticas de antimicrobianos y un mayor riesgo de infecciones nosocomiales. Esta revisión analiza la evidencia más reciente sobre el ajuste de dosis de antimicrobianos en pacientes con ECMO, destacando cambios en volumen de distribución, aclaramiento y secuestro de fármacos en el circuito extracorpóreo. Se identifican fármacos que requieren ajustes posológicos específicos, aquellos sin necesidad de modificación y otros con evidencia limitada. Se resalta la importancia del monitoreo terapéutico y la individualización de la terapia para optimizar resultados clínicos.

Palabras claves

Oxigenación por membrana extracorpórea, antimicrobianos, infecciones nosocomiales.

Abstract

Extracorporeal membrane oxygenation (ECMO) is a life-support modality used in patients with severe cardiopulmonary failure, associated with pharmacokinetic alterations of antimicrobials and an increased risk of nosocomial infections. This review examines the latest evidence on antimicrobial dose adjustments in ECMO patients, focusing on changes in volume of distribution, clearance, and drug sequestration within the extracorporeal circuit. It identifies drugs requiring specific dosing adjustments, those that do not, and others with limited evidence. The importance of therapeutic drug monitoring and individualized therapy is underscored to optimize clinical outcomes.

Keywords

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