Impact of extracorporeal membrane oxygenation on antituberculosis drug concentrations: A case study and pharmaceutical care strategies

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) provides life support for critically ill tuberculosis (TB) patients. However, during ECMO therapy, significant fluctuations in the plasma concentration of anti-TB drugs occur due to drug adsorption in the ECMO circuit, hemodilution, and metabolic disturbances. MATERIALS AND METHODS: This single-case study monitored the plasma concentration of anti-TB drugs in a TB patient supported by ECMO. RESULTS: ) measured at the end of ECMO support vs. 7 days after ECMO withdrawal were as follows: isoniazid (66%), linezolid (63%), ethambutol (56%), and levofloxacin (12%). CONCLUSION: We analyzed ECMO's impact on drug concentrations and implemented therapeutic drug monitoring to optimize therapy. However, this single-case study has inherent limitations; future multi-center studies are warranted to validate these findings.