Abstract

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.

中文翻译：

---

严重肾病早产儿的替莫西林剂量调整：病例报告。

摘要

背景

替莫西林是一种羧基青霉素抗生素，适用于由敏感的产 ESBL 肠杆菌科引起的复杂尿路感染。虽然针对肾功能正常或受损的成年患者的替莫西林治疗方案是基于证据的，但在儿科人群中知之甚少。

目标

我们在此报告了对患有终末期肾病的早产儿进行替莫西林治疗的管理。

患者和方法

该患者是一名 7 个月大的早产儿，孕 35 周出生，因敏感的产 ESBL阴沟肠杆菌复合菌株引起的菌血症性尿路感染接受替莫西林治疗 10 天。替莫西林通过连续输注给药，负荷剂量为 25 mg，随后维持剂量为每天 70 mg。进行了MIC和替莫西林血浆和尿浓度的测定。

结果

在开始替莫西林治疗后 24 小时观察到临床改善。在治疗的第一天和第六天之间，尿液中的替莫西林浓度在 21.6 和 35.5 mg/L 之间，在治疗 6 天和 10 天后，血浆中的替莫西林浓度分别在 47.0 和 61.8 mg/L 之间。发现替莫西林浓度高于确定的 6 mg/L 的 MIC。根据测量的浓度，我们可以假设尿液中达到 100% fT _>MIC，血浆中至少等于 40%。

结论

在本报告病例中进行的替莫西林剂量调整允许安全有效的治疗。本文描述的策略可用作与替莫西林在肾功能不全的儿科人群中使用相关的进一步临床研究的基础。