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Dalbavancin Pharmacokinetics in an 18-Month-Old Child Undergoing Extracorporeal Membrane Oxygenation

Alessia Cafaro1, Giammarco Baiardi2,3, Alessio Mesini4

  • 1Biochemistry, Pharmacology and Newborn Screening Unit, Central Laboratory of Analysis, IRCCS Istituto Giannina, Gaslini, Genova, Italy.

Therapeutic Drug Monitoring
|March 27, 2025
PubMed

Insights

Extracorporeal membrane oxygenation (ECMO) significantly alters dalbavancin pharmacokinetics in children. ECMO increased drug clearance by over twofold, reducing its half-life and potentially impacting treatment efficacy.

Area of Science:

  • Pharmacology
  • Critical Care Medicine
  • Pediatrics

Background:

  • Extracorporeal membrane oxygenation (ECMO) provides life support for severe respiratory or cardiac failure.
  • Drug pharmacokinetics are frequently altered during ECMO, necessitating therapeutic drug monitoring.
  • Maintaining antimicrobial drug concentrations within the therapeutic range is crucial for patient outcomes.

Purpose of the Study:

  • To characterize the pharmacokinetic profile of dalbavancin in a pediatric patient undergoing ECMO.
  • To assess the impact of ECMO on dalbavancin clearance and half-life.

Main Methods:

  • A case presentation describing dalbavancin pharmacokinetics in an 18-month-old child.
  • Noncompartmental analysis was used to evaluate drug disposition during and after ECMO.

Main Results:

  • ECMO significantly increased dalbavancin clearance, estimated at 2.13 times higher compared to post-ECMO.
  • The terminal half-life of dalbavancin was reduced by 52.32% during ECMO (79.13 hours vs. 165.98 hours).

Conclusions:

  • ECMO profoundly alters dalbavancin pharmacokinetics, leading to increased clearance and reduced half-life.
  • These pharmacokinetic changes may result in suboptimal drug exposure, potentially compromising dalbavancin's efficacy during ECMO support.
Abstract

Keywords:
childrendalbavancinextracorporeal membrane oxygenationpharmacokineticstherapeutic drug monitoring

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