Biapenem has been used in pediatric patients as well as adult patients; however, little information is available on dosing regimens for pediatric patients. This study examined biapenem pharmacokinetics in pediatric population and performed pharmacokinetic-pharmacodynamic analysis. Biapenem plasma concentrations from 10 pediatric patients were pharmacokinetically analyzed. A multi-regression analysis showed the pharmacokinetic parameters were affected by body weight and creatinine clearance of the patients. Using the pharmacokinetic parameters, a Monte Carlo simulation predicted the probabilities of attaining the pharmacodynamic target (40% of the time above the minimum inhibitory concentration for the bacterium). In the case of about 20kg, biapenem regimens of 5mg/kg b.i.d. and 10mg/kg b.i.d. provided sufficient target attainment probabilities against Streptococcus pneumoniae and Pseudomonas aeruginosa isolates, respectively. Our results should provide a PK-PD-based guidance for rationalizing biapenem regimen according to the body weight and renal function of a pediatric patient and the specific bacterium suspected.

Ceftazidime (CAZ), a cephem antibiotic for injection, was administered at dose of one gram q.i.d. to adult hospital-acquired pneumonia patients, and the clinical efficacy and blood concentration of CAZ was studied in five cases.

The assessment of clinical efficacy was “efficacy” in all cases, and early improvement of examination value including body temperature, the value of CRP, and white blood cell counts were obtained. Abnormality of hepatic function as adverse effect was noted in two cases. However, the severity was mild and didn’t affect the treatment in both cases.

The maximum drug concentration immediately after the end of infusion was 72.1～176.56μg/mL (median, 82.76μg/mL) and the trough level was 5.1～72.16μg/mL (median, 26.66μg/mL), therefore the blood concentration was maintained a higher level than the MIC of bacteria estimated to be causative.

From these results, administration method of ceftazidime one gram q.i.d. was considered to be a good way with increase of drug efficacy by maintaining highly blood concentration over prolonged period, and expected to be a good effect for hospital–acquired pneumonia.

There have been some reports on the efficacy and tolerability of itraconazole (ITCZ) as prophylaxis for fungal infection after HSCT, and guidelines recommend itraconazole as a standard drug for prophylaxis of fungal infection in HSCT patients.

However, it is not uncommon for patients undergoing HSCT to develop anorexia and taste disturbance. There are some cases where the bitter taste of ITCZ oral solution leads to interruption of administration because the patient refuses to take this medicine. Therefore, we investigated the clinical utility and influence on continuing treatment adherence by jellification of ITCZ. Compared with ITCZ oral solution, jellified ITCZ was extremely easy for most patients to take, and it was suggested that jellified ITCZ can make it easier for patients to continue treatment if they have difficulty with administration because of the bitter taste of ITCZ oral solution.

Furthermore, it was confirmed that the plasma concentration of ITCZ was suitable for prophylaxis even with jellified ITCZ. This also suggested that the efficacy of ITCZ would be maintained by using jellified formation.

For long-term antifungal therapy in patients with a high risk of fungal infection such as those having HSCT, it is very important for successful prophylaxis to maintain good adherence.