Temocillin dosage adjustment in a preterm infant with severe renal disease: a case report

Dumangin, Guillaume; Brenkman, Matthieu; Pape, Elise; Kolodziej, Allan; Gambier, Nicolas; Vrillon, Isabelle; Charmillon, Alexandre; Scala‐Bertola, Julien

doi:10.1093/jac/dkaa356

Cited by 5 publications

(2 citation statements)

References 14 publications

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“…Plasma levels were 47.0 and 61.8 mg/L after 6 and 10 days of treatment, respectively, with an estimated free concentration of 7.0 and 9.2 mg/L. Free plasma concentrations were estimated to be above the MIC during the last 4 days of treatment, with a minimum of 40% f T >MIC ( 47 ). Temocillin dosing was adjusted with a reduction by 0.6-, 0.3-and 0.1-fold for a CrCL of 60, 30 and 10 mL/min/1.73 m 2 , respectively, according to the available data from the literature, as reported above.…”

Section: Resultsmentioning

confidence: 99%

Anti-infective Medicines Use in Children and Neonates With Pre-existing Kidney Dysfunction: A Systematic Review

et al. 2022

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BackgroundDosing recommendations for anti-infective medicines in children with pre-existing kidney dysfunction are derived from adult pharmacokinetics studies and adjusted to kidney function. Due to neonatal/pediatric age and kidney impairment, modifications in renal clearance and drug metabolism make standard anti-infective dosing for children and neonates inappropriate, with a risk of drug toxicity or significant underdosing. The aim of this study was the systematic description of the use of anti-infective medicines in pediatric patients with pre-existing kidney impairment.MethodsA systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The EMBASE, Medline and Cochrane databases were searched on September 21st, 2021. Studies in all languages reporting data on pre-defined outcomes (pharmacokinetics-PK, kidney function, safety and efficacy) regarding the administration of anti-infective drugs in children up to 18 years with pre-existing kidney dysfunction were included.Results29 of 1,792 articles were eligible for inclusion. There were 13 case reports, six retrospective studies, nine prospective studies and one randomized controlled trial (RCT), reporting data on 2,168 pediatric patients. The most represented anti-infective class was glycopeptides, with seven studies on vancomycin, followed by carbapenems, with five studies, mostly on meropenem. Antivirals, aminoglycosides and antifungals counted three articles, followed by combined antibiotic therapy, cephalosporins, lipopeptides with two studies, respectively. Penicillins and polymixins counted one study each. Nine studies reported data on patients with a decreased kidney function, while 20 studies included data on kidney replacement therapy (KRT). Twenty-one studies reported data on PK. In 23 studies, clinical outcomes were reported. Clinical cure was achieved in 229/242 patients. There were four cases of underdosing, one case of overdosing and 13 reported deaths.ConclusionThis is the first systematic review providing evidence of the use of anti-infective medicines in pediatric patients with impaired kidney function or requiring KRT. Dosing size or interval adjustments in pediatric patients with kidney impairment vary according to age, critical illness status, decreased kidney function and dialysis type. Our findings underline the relevance of population PK in clinical practice and the need of developing predictive specific models for critical pediatric patients.

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Section: Resultsmentioning

confidence: 99%

Anti-infective Medicines Use in Children and Neonates With Pre-existing Kidney Dysfunction: A Systematic Review

et al. 2022

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“…5 Currently, temocillin is only licensed in Belgium, France, the UK, Germany, Luxembourg and Iran. 6 , 7 …”

Section: Introductionmentioning

confidence: 99%

Clinical and microbiological evaluation of temocillin for bloodstream infections with Enterobacterales: a Belgian single-centre retrospective study

Oosterbos

Schalkwijk

Thiessen

et al. 2022

JAC-Antimicrobial Resistance

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Background Expanding the use of temocillin could be an important weapon in the fight against antimicrobial resistance. However, EUCAST defined clinical breakpoints for a limited number of species and only for urinary tract infections (UTI), including urosepsis but excluding severe sepsis and septic shock. Moreover, a dosage of 2 g q8h is advised in most cases. Objectives Evaluation of temocillin use for the treatment of bacteraemia, correlating clinical and microbiological outcomes with infection site, infection severity, temocillin dosage, Enterobacterales species and MIC. Patients and methods All adult patients with blood cultures positive for temocillin-susceptible Enterobacterales and treated with temocillin for ≥72 h from June 2018 until June 2021 were considered for inclusion. The primary outcome was clinical success, defined as resolution of infection signs, no relapse of the same infection and no antibiotic switch due to insufficient clinical improvement. The secondary outcome was microbiological success. Results In total, 182 episodes were included [140 UTI versus 42 non-UTI, 171 Escherichia coli, Klebsiella species (except Klebsiella aerogenes) and Proteus mirabilis (EKPs) versus 11 non-EKPs]. Clinical and microbiological failure were low (8% and 3%, respectively). No difference in outcome was observed for dosages of 2 g q12h versus 2 g q8h, either for EKP versus non-EKP isolates or MIC values ≤8 versus 16 mg/L. Considering only bacteraemia episodes of UTI origin, using the 16 mg/L breakpoint, there was no difference in success rate between regimens of 2 g q12h and 2 g q8h. Conclusions Temocillin 2 g q12h can be successfully used for the treatment of systemic UTI. Prospective studies are needed to assess outcomes and evaluate non-inferiority compared with other broad-spectrum antibiotics in non-UTI infections, including bacteraemia.

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Population pharmacokinetics and dosing simulations of temocillin in liver transplanted paediatric patients: a prospective, open-label, non-randomized study

Pokem,

Stéphenne,

Liu

et al. 2024

Clinical Microbiology and Infection

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Temocillin dosage adjustment in a preterm infant with severe renal disease: a case report

Cited by 5 publications

References 14 publications

Anti-infective Medicines Use in Children and Neonates With Pre-existing Kidney Dysfunction: A Systematic Review

Anti-infective Medicines Use in Children and Neonates With Pre-existing Kidney Dysfunction: A Systematic Review

Clinical and microbiological evaluation of temocillin for bloodstream infections with Enterobacterales: a Belgian single-centre retrospective study

Population pharmacokinetics and dosing simulations of temocillin in liver transplanted paediatric patients: a prospective, open-label, non-randomized study

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