# Effect of therapeutic plasma exchange on amoxicillin, clindamycin, midazolam, and morphine pharmacokinetics in a critically ill child

## TL;DR

This case report shows how therapeutic plasma exchange affects drug levels in a critically ill child, highlighting the need for drug monitoring.

## Contribution

Demonstrates real-world pharmacokinetic changes of specific drugs during therapeutic plasma exchange in a critically ill pediatric patient.

## Key findings

- Therapeutic plasma exchange caused significant reductions in plasma concentrations of amoxicillin, clindamycin, and midazolam.
- Drug monitoring is essential to adjust dosing during extracorporeal therapies in critically ill patients.
- Morphine levels were less affected compared to other drugs during plasma exchange.

## Abstract

We report a 15-year-old boy with severe septic shock and multiple organ failure, requiring intensive care and extracorporeal therapies, including veno-arterial extracorporeal membrane oxygenation, continuous veno-venous hemodiafiltration, and therapeutic plasma exchange. Given their critical role in the clinical management, pharmacokinetics of amoxicillin, clindamycin, midazolam, and morphine were closely monitored. Drug concentrations were measured before, during, and after therapeutic plasma exchange sessions. Despite theoretical predictions, clinically significant reductions in plasma drug concentrations of amoxicillin, clindamycin, and midazolam were observed following therapeutic plasma exchange. This case report emphasizes the necessity of therapeutic drug monitoring to adjust dosing appropriately and optimize patient outcomes.