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

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.