35.下列何者最不容易經由連續性靜脈靜脈血液過濾（CVVH）移除？
(A)cefuroxime
(B)cefotaxime
(C)ceftriaxone
(D)cefepime

連續性靜脈對靜脈血液過濾術 Continuous venovenous hemofiltration（CVVH）

放入一枝雙腔導管至大靜脈中，以24小時不中斷方式，低血液流速(約150-200ml/minute)，緩慢地清除體內多餘水分和尿毒素。

當時解題判斷此方法應較為類似腎排，因此選擇Cephalosporin中肝排者 (C) ceftriaxone

抗生素中非腎排者 [肝臟代謝、膽汁排除]

△Naficillin、Oxacillin

△Cefamandole、Ceftriaxone、Cefoperazone

△Doxycycline、Minocycline

△Macrolide類除了Clarithromycin 

△Chloramphenicol

△Moxifloxacin、Gemifloxacin

Ceftriaxone 

Protein binding：85-95%

Ref. Uptodate

Ceftriaxone is the exception in this group of β-lactams, primarily because of its extensive protein-binding capacity, which prevents it from being filtered, and its hepatic metabolism and biliary excretion.

https://academic.oup.com/cid/article/41/8/1159/378983

The fraction of ceftriaxone bound to plasma proteins was 43 +/- 15% (range 13-92%).  The fraction unbound to plasma proteins (f(up)) at the time that SCs were determined was significantly lower in the PS group (0.16 +/- 0.07) than the AN69 group (0.30 +/- 0.17, p<0.01), but similar to that in the PMMA group (0.27 +/- 0.12) (3種濾膜的sieving coefficient). Despite the higher f(up), the SC of unbound ceftriaxone with the AN69 filter (0.48 +/- 0.13) was significantly lower than values for the PMMA (0.86 +/- 0.33) and PS (0.82 +/- 0.22) groups (p<0.05). Ceftriaxone clearance was significantly increased and membrane dependent during continuous venovenous hemofiltration and continuous venovenous hemodialysis. (總之不會到100%經CRRT排除)

https://pubmed.ncbi.nlm.nih.gov/10853618/

其他抗生素幾乎可100%經CCRT排除(因人而異)。