PHARMACOKINETICS OF TICARCILLIN‐CLAVULANATE IN PREMATURE INFANTS

Abstract

Ticarcillin‐clavulanate covers a broad spectrum of pathogens that are common in premature infants. In infants <30 weeks gestational age, pharmacokinetic data to guide ticarcillin‐clavulanate dosing are lacking. We enrolled 15 premature infants <30 weeks gestational age, determined pharmacokinetic parameters, and performed dosing simulations to determine optimal dosing for ticarcillin‐clavulanate. The infants had a median (range) postnatal age (PNA) of 18 days (6‐44) and gestational age of 25 weeks (23‐28). Clearance was lower in infants with a PNA <14 days (0.050 L/kg/h [range 0.043‐0.075]) compared with a PNA ≥14‐45 days (0.078 L/kg/h [0.047‐0.100]), consistent with maturation of renal function. Dosing simulations determined that ticarcillin 75 mg/kg q12h (PNA <14d) or q8h (PNA ≥14‐45d) achieved the target exposure for organisms with an MIC ≤16 μ/mL in >90% of simulated infants. For highly resistant organisms (MIC 32 μg/mL), increased dosing frequency or extended infusion are necessary.

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