Low-dose sulbactam-durlobactam for recurrent CRAB pneumonia in a child with cerebral palsy: a Case Report from a resource-limited setting.

BACKGROUND: Pediatric data for sulbactam-durlobactam (SUL-DUR) are extremely scarce, and no standard pediatric dosing exists. METHODS: We report a 6-year-old boy with cerebral palsy and epilepsy who developed recurrent ventilator-associated pneumonia caused by OXA-23-producing carbapenem-resistant Acinetobacter baumannii (CRAB). RESULTS: Due to financial constraints, a reduced-dose SUL-DUR regimen (150 mg/kg/day, q6h, 3-h infusion) was combined with cefoperazone-sulbactam to achieve a total sulbactam dose of 150 mg/kg/day. The patient defervesced within 48 h, inflammatory markers declined, chest imaging improved markedly, and he was transferred out of the PICU after 12 days of therapy. CONCLUSION: A PK/PD-driven low-dose SUL-DUR strategy may represent a feasible and potential cost-saving strategy for pediatric CRAB pneumonia in resource-limited settings.