The impact of hemoadsorption on antimicrobials

Hemoadsorption (HA) is used for supportive blood purification therapy for conditions such as sepsis and immunological diseases. However, it may cause unintentional removal of antimicrobial drugs, potentially offsetting its therapeutic benefits. This review provides an overview of the impact of HA on the clearance of antimicrobials. We reviewed in vitro and in vivo studies on antimicrobial drug removal by HA. Current evidence suggests that HA can significantly affect the clearance of antimicrobials. However, the adsorptive clearance varies widely across different drugs and sorbents, and these interactions cannot be predicted based on molecular weight or characteristics. Drug removal by HA typically decreases over time. Also, the impact of HA on overall clearances is likely highly heterogeneous, depending on the sorbents used, patient, and the intervention applied. Some clinical studies, though limited, suggests the necessity of dose adjustments during HA. Clinicians need to understand these effects and appreciate their magnitude to deliver optimal care. Further investigation is required to provide comprehensive information for dosing, timing, and monitoring strategies during HA.