Dr. Vissagan Sankaranarayanan
East Suffolk and North Essex NHS Foundation Trust, UK
Abstract Title: Pharmacokinetics and Stability of Antimicrobials Delivered via Elastomeric Devices in Paediatric Patients: A Systematic Review
Biography: Vissagan Sankaranarayanan is a junior doctor with clinical and academic experience in paediatric and oncology research. He completed an MPhil in Paediatric Oncology at the University of Liverpool and has worked on projects investigating novel biomarkers and antimicrobial delivery systems. His research interests include drug delivery, translational immuno-oncology, and optimising outpatient care models in paediatrics. He has presented work at national and international meetings and is pursuing further research training in clinical oncology.
Research Interest: Statement of the Problem: Elastomeric infusion devices (EDs) are portable, power-free pumps that enable continuous antimicrobial delivery in outpatient settings. Their use is established in adult outpatient parenteral antimicrobial therapy (OPAT), but paediatric application remains poorly characterised. Key concerns include drug stability, pharmacokinetics, device reliability, and clinical outcomes. Methodology & Theoretical Orientation: A systematic review was conducted according to PRISMA guidelines (registered PROSPERO CRD42021237146). Databases searched up to December 2023 included Medline, Embase, CINAHL, PubMed, Cochrane Clinical Trials Library, ClinicalTrials.gov and WHO ICTRP. Eligible studies enrolled patients aged 0–21 years receiving antimicrobials via EDs. Outcomes included antimicrobial agents administered, infusion durations, stability and diluent requirements, pharmacokinetics, device/line complications, treatment completion, and patient-reported experiences. Findings: Nine studies from six countries, including 567 patients and 657 treatment episodes, were identified. Fourteen antibiotics and one antiviral were delivered, predominantly as 24-hour continuous infusions with median treatment courses of 10–15 days (maximum 84 days). Stability testing showed molecule-specific constraints: β-lactams such as ceftazidime required shorter infusion windows, while buffering extended stability for agents including flucloxacillin. Pharmacokinetic data from 28 paediatric patients demonstrated ceftazidime steady-state concentrations (56.2 ± 23.2 μg/mL) significantly above intermittent dosing troughs (12.1 ± 8.7 μg/mL, p<0.05). Device failures were rare (<5%), line complications occurred in ~10% of episodes, and adverse drug reactions were infrequent. Clinical success exceeded 90% across most cohorts, with families reporting strong preference for ED therapy due to convenience and reduced hospitalisation. Conclusion & Significance: EDs appear to be a safe, feasible, and effective mode of antimicrobial delivery for children and young adults, ensuring sustained therapeutic exposure with high treatment success and minimal device-related issues. Integration into paediatric OPAT services may improve quality of life and reduce healthcare burden. Further research into pharmacokinetics and stability is needed to optimise paediatric dosing strategies.