High-dose sulbactam tied to greater Cmid, PK-PD achievement

Treatment with high-dose sulbactam leads to higher mid-dosing (Cmid) and pharmacokinetic-pharmacodynamic (PK-PD) achievement in paediatric patients, reports a study.

A team of investigators analysed prospective data (January‒November 2023) on children aged 1 month to 18 years who received sulbactam every 6‒8 hours. They also evaluated Cmid (50 percent fT) and trough (Ctrough, 100 percent fT) concentrations.

Finally, the investigators evaluated PK-PD target achievement (50 percent fT > minimum inhibitory concentration [MIC], 100 percent fT > MIC) using Clinical and Laboratory Standards Institute 2024 MIC cutoffs and MIC data of isolates of Acinetobacter calcoaceticus‒baumannii complex from this study.

Thirty-five patients (median age 50 months) were included and categorized into two groups: standard dose and high dose. The geometric mean Cmid was higher in the high-dose than the standard-dose groups (41.3 vs 19.5 mg/L; p=0.006).

Among 101 isolates of A. calcoaceticus‒baumannii complex, the MIC50 and MIC90 (concentrations inhibiting 50 percent and 90 percent of isolates) were 16 and 128 mg/L, respectively.

More patients in the high-dose group achieved Cmid >MIC50 than those in the standard-dose group (87.5 percent vs 63.6 percent; p=0.17). Among patients in the high-dose group, those with augmented renal clearance (ARC) showed lower Cmid (geometric mean 31.9 mg/L) than those with non-ARC (geometric mean 63.4 mg/L; p=0.04).

“HD sulbactam may be preferable for treating critically ill paediatric patients and those with ARC, especially during the empirical period,” the investigators said.