Ceftaroline pharmacokinetics on ECMO, a pediatric case report

In-vitro studies suggest that patients on extracorporeal membrane oxygenation (ECMO) may struggle to achieve therapeutic ceftaroline exposure to treat infections due to antibiotic sequestration within the ECMO oxygenator; however, there are no published data regarding ceftaroline concentrations from patients supported by ECMO.

Here we present an analysis of ceftaroline pharmacokinetics in a 5-y-old patient supported on ECMO due to influenza-associated necrotizing pneumonia.

A total of nine concentrations were analyzed, including three concentrations prior to cannulation and six on ECMO. ECMO cannulation was associated with a relatively small change in the volume of distribution (0.17 L/kg to 0.20 L/kg) and clearance (1.00 mL/min/kg to 0.86 mL/min/kg). This patient continued to achieve 100%-time above MIC while on ECMO. Substantial adsorption or sequestration were not observed in this circuit using a Nautilus oxygenator.

This case report demonstrates that achieving therapeutic ceftaroline concentrations for patients on ECMO may be feasible using current oxygenators. Clinicians could consider continuing ceftaroline therapy following ECMO cannulation for patients achieving good microbiologic response.