Ceftaroline pharmacokinetics on ECMO, a pediatric case report.

Creator(s)

• Kathryn Pavia, Children's Mercy Kansas CityFollow
• Ashton Bellamy, Children's Mercy Kansas City
• Alaina Burns, Children's Mercy Kansas CityFollow
• Allison Scott, Children's Mercy HospitalFollow
• Ethan A. Poweleit, Children's Mercy Kansas CityFollow

Document Type

Article

Publication Date

10-2026

Identifier

DOI: 10.1016/j.ijantimicag.2026.107896; PMCID: PMC13470868

Abstract

BACKGROUND: 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.

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

RESULTS: 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.

CONCLUSIONS: 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.

Journal Title

International journal of antimicrobial agents

Volume

67

Issue

10

First Page

107896

Last Page

107896

MeSH Keywords

Child, Preschool; Humans; Male; Anti-Bacterial Agents; Ceftaroline; Cephalosporins; Extracorporeal Membrane Oxygenation; Pneumonia, Necrotizing

PubMed ID

42362070

Keywords

Pediatric; ECMO; Beta-lactams; Ceftaroline; Critical illness; Pharmacokinetics

Comments

Grants and funding

• K12 HD113189/HD/NICHD NIH HHS/United States
• T32 HD069038/HD/NICHD NIH HHS/United States

This article is available under the Creative Commons CC-BY-NC-ND license and permits non-commercial use of the work as published, without adaptation or alteration provided the work is fully attributed.

Publisher's Link: https://www.sciencedirect.com/science/article/pii/S0924857926001834?via%3Dihub

Recommended Citation

Pavia K, Bellamy A, Burns A, Scott A, Poweleit EA. Ceftaroline pharmacokinetics on ECMO, a pediatric case report. Int J Antimicrob Agents. 2026;67(10):107896. doi:10.1016/j.ijantimicag.2026.107896