Antibiotics and Other Drugs Removal by the CytoSorb® Haemoadsorber: A Systematic Review of Available Evidence

Background/Objectives: Haemoadsorption has recently emerged as an extracorporeal treatment option for sepsis, septic shock, intoxications, and cardiac surgery to modulate dysregulated inflammatory responses or remove a wide range of circulating molecules. To ensure appropriate clinical use of the CytoSorb® haemoadsorber, it is essential to understand the extent to which specific drugs are adsorbed by the device. Methods: We conducted a systematic literature review using the PubMed and Ovid MEDLINE database to identify studies on drug binding to the CytoSorb® haemoadsorber, including both in vivo and in vitro studies. Publications in English language, available up to 31 December 2025 that reported or enabled calculation of percentage of drug removal, CytoSorb® clearance or half-life during CytoSorb® therapy were included. Records were screened, eligibility and quality were assessed, and data were extracted independently by two reviewers. Results: We found that 26 studies reported on the binding of 56 drugs to CytoSorb®, with most available information relating to antibiotics used in the treatment of sepsis and septic shock. CytoSorb® appears to remove vancomycin and linezolid but not meropenem, although data for other antibiotics are insufficient to assess clinical relevance. Data on the removal of anticoagulant and antithrombotic drugs with CytoSorb® before and during cardiac surgery indicate that using this procedure to reduce complications associated with apixaban and ticagrelor is feasible and safe. The available evidence on the use of CytoSorb® for drug poisoning is of very low quality. Conclusions: Although the number of studies on drug binding to the CytoSorb® is increasing, the review is limited by the marked heterogeneity among the included studies. It is advised to use therapeutic drug monitoring whenever possible during CytoSorb® treatment. Research of binding of drugs to CytoSorb® is crucial for its safe and effective clinical use, but adequate methodology is necessary.