[Effect of extracorporeal membrane oxygenation on pharmacokinetics of antimicrobial drugs: recent progress and recommendations].

Extracorporeal membrane oxygenation (ECMO) is an effective means to provide life support for patients with severe respiratory or heart failure. Existing studies have shown that ECMO may affect the metabolic process of some drugs by drug adsorption, increasing the apparent distribution volume and changing the clearance rate of the drugs. This review summarizes the recent progress in the studies of the effect of ECMO on the pharmacokinetics of antibacterial and antifungal drugs. For the antibacterial drugs, it is recommended that the dose of teicoplanin, imipenem, and linezolid should be increased during ECMO support, while the dose of azithromycin, ciprofloxacin, and tigecycline should not be modified for the time being. Currently studies on pharmacokinetic changes of antifungal drugs during ECMO support remain limited. Voriconazole can be absorbed substantially by ECMO due to its high lipophilicity, and higher doses are therefore recommended. The dose of micafungin also needs to be increased in children undergoing ECMO. However, current evidence concerning the dose of caspofungin and fluconazole are limited, and it is not clear whether the routine dose should be adjusted during ECMO support.