Cefoperazone-Sulbactam Dosing in Children
The recommended dose of cefoperazone-sulbactam in children is 100-150 mg/kg/day divided every 6-8 hours, with a maximum of 160 mg/kg/day for severe infections. This dosing recommendation is based on clinical guidelines and pharmacokinetic studies in pediatric patients.
Dosing Recommendations
- Standard dosing: 100-150 mg/kg/day divided every 6-8 hours 1
- Severe infections: Up to 160 mg/kg/day 2
- Administration method: Intravenous infusion (typically over 1 hour)
Pharmacokinetic Considerations
The dosing of cefoperazone-sulbactam should take into account several important factors:
- Weight-based dosing: Current body weight significantly affects the pharmacokinetics of cefoperazone in children 2
- Half-life: The half-life of cefoperazone is approximately 3.6 hours, while sulbactam has a shorter half-life of 1.77 hours 3
- Clearance: Children may have higher clearance rates than adults, necessitating more frequent dosing
Clinical Efficacy Based on MIC
The probability of achieving therapeutic targets depends on the minimum inhibitory concentration (MIC) of the targeted pathogen:
- For pathogens with MIC ≤16 μg/mL: Standard dosing (100-150 mg/kg/day) is effective 2
- For pathogens with MIC of 16 μg/mL: Higher dosing (160 mg/kg/day) may be required 2
- For pathogens with MIC >16 μg/mL: Cefoperazone-sulbactam may not be the preferred choice 2
Administration Strategies
- Intermittent infusion: For less severe infections or pathogens with lower MICs
- Extended infusion (3 hours): Improves probability of target attainment for MIC of 0.5 mg/L 2
- Continuous infusion: Recommended for higher MICs (8-16 mg/L) to maximize time above MIC 2
Clinical Considerations
- Cefoperazone-sulbactam has shown high efficacy (>90%) in pediatric respiratory infections, pneumonia, and other bacterial infections 4
- The drug has been successfully used in children as young as 7 months of age 5
- Monitor for potential side effects, including:
- Elevated liver enzymes (GOT/GPT)
- Gastrointestinal effects (diarrhea)
- Eosinophilia 5
Important Caveats
- Dosing should be adjusted in patients with renal or hepatic impairment
- For meningitis or CNS infections, other antibiotics may be preferred as cefoperazone penetration into CSF may be limited
- The ratio between cefoperazone and sulbactam at 1:1 may be more suitable for pediatric sepsis 3
While clinical studies support the efficacy and safety of cefoperazone-sulbactam in pediatric infections, therapeutic drug monitoring may be beneficial in critically ill children to ensure optimal dosing while minimizing toxicity.