Thrice-weekly post-haemodialysis ceftazidime can achieve adequate pre-dialysis concentrations and clinical cure in patients with melioidosis

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BACKGROUND: Melioidosis is an opportunistic infection caused by Burkholderia pseudomallei. Prolonged IV antibiotic therapy is required to cure the disease. Current guidelines recommend daily ceftazidime for people receiving chronic intermittent haemodialysis (CIHD). METHODS: We reviewed all cases of culture-confirmed B. pseudomallei infection from 2016 to 2025. In patients receiving CIHD, we recorded their weekly CIHD schedule, their ceftazidime dosing regimen, the ceftazidime MIC for their initial B. pseudomallei isolate and all pre-dialysis ceftazidime concentrations. RESULTS: There were 449 cases of melioidosis; 26 (5.8%) occurred in people already receiving-or who were commenced on-CIHD during their hospital admission. Of these, 24 (92%) survived to the completion of their intensive IV phase of antibiotic therapy. There were nine who had ceftazidime pre-dialysis concentrations measured. Of these, eight were commenced on ceftazidime 2 g daily, but five had their dosing regimen changed; this was a daily dose reduction in three and a change to thrice-weekly dosing regimen of 2 g/2 g/3 g post-haemodialysis in two. One patient was administered thrice-weekly dosing post-haemodialysis for the duration of their intensive phase. No cases had evidence of neurotoxicity, all received oral eradication therapy, and all had clinical cure. CONCLUSIONS: In patients receiving thrice-weekly CIHD, post-haemodialysis ceftazidime administered 2 g/2 g/3 g achieved adequate serum pre-dialysis concentrations, can achieve good clinical outcomes and may be a potential treatment approach for people with melioidosis. The availability of therapeutic drug monitoring and clinical breakpoints suggest a more individualized approach is possible in people with melioidosis receiving CIHD.

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