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Temocillin dosage adjustment in a preterm infant with severe renal disease: a case report
Guillaume Dumangin1, Matthieu Brenkman1, Elise Pape1,2
1Université de Lorraine, CHRU-Nancy, Department of Clinical Pharmacology and Toxicology, F-54000 Nancy, France.
Insights
Temocillin treatment was successfully managed in a preterm infant with end-stage renal disease. Dosing adjustments ensured effective antibiotic concentrations for a urinary tract infection caused by ESBL-producing bacteria.
Area of Science:
- Pharmacology
- Pediatric Nephrology
- Infectious Diseases
Background:
- Temocillin is a carboxypenicillin antibiotic used for complicated urinary tract infections (UTIs) caused by susceptible ESBL-producing Enterobacteriaceae.
- Established temocillin dosing regimens exist for adults but are lacking for pediatric populations, especially those with renal impairment.
Observation:
- A 7-month-old preterm infant (35 weeks gestation) with end-stage renal disease received temocillin for a bacteraemic UTI caused by Enterobacter cloacae.
- Temocillin was administered via continuous infusion with a loading dose (25 mg) and daily maintenance dose (70 mg).
- Plasma and urinary temocillin concentrations, along with the minimum inhibitory concentration (MIC), were monitored throughout the 10-day treatment course.
Findings:
- Clinical improvement was noted within 24 hours of initiating temocillin.
- Achieved therapeutic temocillin concentrations: urine (21.6–35.5 mg/L) and plasma (47.0–61.8 mg/L).
- Concentrations consistently exceeded the MIC (6 mg/L), achieving 100% time above MIC in urine and at least 40% in plasma.
Implications:
- Adjusted temocillin dosing facilitated safe and effective treatment in a preterm infant with renal disease.
- This case provides a basis for future studies on temocillin use in pediatric patients with impaired renal function.
- Optimized temocillin dosing strategies are crucial for treating complex infections in vulnerable pediatric populations.
Background:
Temocillin is a carboxypenicillin antibiotic indicated in complicated urinary tract infections due to susceptible ESBL-producing Enterobacteriaceae. While temocillin therapeutic schemes for adult patients with normal or impaired renal function are evidence based, little is known in paediatric populations.
Objectives:
We report herein the management of temocillin treatment in a preterm infant with end-stage renal disease.
Patients And Methods:
The patient was a 7-month-old preterm infant born at 35 weeks gestation and treated by temocillin for 10 days for a bacteraemic urinary tract infection due to a susceptible ESBL-producing Enterobacter cloacae complex strain. Temocillin was administered by continuous infusion using a loading dose of 25 mg followed by a maintenance dose of 70 mg daily. Determination of MIC and temocillin plasma and urinary concentration was performed.
Results:
Clinical improvement was observed 24 h after the initiation of temocillin treatment. Temocillin concentrations ranged between 21.6 and 35.5 mg/L in urine between the first and the sixth day of treatment and between 47.0 and 61.8 mg/L in plasma after 6 and 10 days of treatment, respectively. Temocillin concentrations were found to be above the determined MIC of 6 mg/L. From the measured concentrations, we can postulate that 100%fT>MIC was achieved in urine and at least equal to 40% in plasma.
Conclusions:
Temocillin dosing adjustment performed in the present reported case allowed safe and effective treatment. The strategy described herein could be used as a basis for further clinical studies relative to temocillin use in a paediatric population with renal impairment.
