Nov 7, 2019

Target-Controlled Infusion of Cefepime in Critically Ill Patients

Antimicrobial Agents and Chemotherapy
Stijn JonckheerePieter J Colin

Abstract

Attainment of appropriate pharmacokinetic-pharmacodynamic (PK-PD) targets for antimicrobial treatment is challenging in critically ill patients, particularly for cefepime, which exhibits a relative narrow therapeutic-toxic window compared to other beta-lactam antibiotics. Target-controlled infusion (TCI) systems, which deliver drugs to achieve specific target drug concentrations, have successfully been implemented for improved dosing of sedatives and analgesics in anesthesia. We conducted a clinical trial in an intensive care unit (ICU) to investigate the performance of TCI for adequate target attainment of cefepime. Twenty-one patients treated with cefepime according to the standard of care were included. Cefepime was administered through continuous infusion using TCI for a median duration of 4.5 days. TCI was based on a previously developed population PK model incorporating the estimated creatinine clearance based on the Cockcroft-Gault formula as the input variable to calculate cefepime clearance. A cefepime blood concentration of 16 mg/liter was targeted. To evaluate the measured versus predicted plasma concentrations, blood samples were taken (median of 10 samples per patient), and total cefepime concentrations were measur...Continue Reading

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Mentioned in this Paper

Monobactams
Creatinine
FAM3C protein, human
Analgesics
Anesthesia Procedures
Mass Spectrometry
Intensive Care Unit
Absolute Alcohol
Pharmacologic Substance
Plasma

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