Objective: To determine whether in critically ill patients with renal failure on intermittent hemodialysis (HD), removal of linezolid by HD adversely affects serum antibiotic concentrations. Methodology: Five male critically ill patients (mean age, 75 years; range, 68-82 years; APACHE H score, 26.4; range, 23-29; survival, two of five) with sepsis and renal failure on hemodialysis, were administered IV linezolid, 600 mg every 12 h. Serum antibiotic levels were measured by high-performance liquid chromatography/mass spec-trometry. Trough concentrations were classified as "with HD" when a HD session was performed after linezolid infusion and "without HD" otherwise. Population pharmacokinetics were also computed while patients were on and off dialysis. Results: A total of 222 serum linezolid concentrations were available over 36 days of antibiotic therapy, during which patients underwent 31 HD sessions. Trough serum linezolid levels averaged 5.83 mg/L (range, 1.48-15.84 mg/L), exceeding 4.0 mg/Lin 68.9% of samples; however, trough levels "with HD" were lower than those "without HD" (4.68 mg/L vs 6.74 mg/L;p < .001). Clearance and half-life were 6.0 L/h and 4.0 h, respectively, while patients were on dialysis, and 4.4 L/h and 7.3 h, respectively, when they were off dialysis.
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