Title:Ceftobiprole and Cefiderocol for Patients on Extracorporeal Membrane Oxygenation: The Role of Therapeutic Drug Monitoring
Volume: 25
Issue: 7
Author(s): Diana Morales Castro*, John Granton and Eddy Fan
Affiliation:
- Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, University of Toronto, Toronto, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
Keywords:
Antibiotics, extracorporeal membrane oxygenation, renal replacement therapy, therapeutic drug monitoring, drug resistance, MDR.
Abstract:
Introduction: Limited data exist on therapeutic ranges for newer antimicrobials in the critically ill,
with few pharmacokinetic studies including patients undergoing renal replacement therapy or extracorporeal
membrane oxygenation (ECMO).
Case Representation: These interventions can potentially alter the pharmacokinetic profile of antibiotics, resulting
in therapeutic failures, antimicrobial resistance, or increased toxicity. In this report, we present two ECMO
patients treated with cefiderocol and ceftobiprole, where therapeutic drug monitoring (TDM) aided in the
successful treatment of severe infections. Antibiotic trough concentrations in both cases were consistent with
previously reported therapeutic levels in critically ill and ECMO patients, meeting minimal inhibitory concentrations
recommended by the European Committee on Antimicrobial Susceptibility Testing for the respective
pathogens.
Conclusion: Treatment might be suboptimal if doses are not adjusted based on physicochemical properties
and extracorporeal support. In an era marked by highly resistant pathogens, these cases highlight the importance
of timely access to real-time TDM for optimizing and individualizing antimicrobial treatment.
