1. Three-times-weekly, post-dialysis cefepime therapy in patients on maintenance hemodialysis: a retrospective study
- Author
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Veronique Erard, Christian Chuard, Ould Maouloud Hemett, Filipe Martins, and Eric Descombes
- Subjects
Male ,0301 basic medicine ,medicine.medical_treatment ,030232 urology & nephrology ,Gastroenterology ,Cohort Studies ,0302 clinical medicine ,Outpatient clinic ,Pharmacology (medical) ,Cefepime ,Infusions, Intravenous ,Middle Aged ,Staphylococcal Infections ,Anti-Bacterial Agents ,Beta-lactam antibiotics ,Hemodialysis ,Anesthesia ,Female ,Drug Monitoring ,medicine.symptom ,Research Article ,medicine.drug ,Staphylococcus aureus ,medicine.medical_specialty ,Outpatient Clinics, Hospital ,030106 microbiology ,Renal function ,Microbial Sensitivity Tests ,Anuria ,Drug Administration Schedule ,03 medical and health sciences ,Pharmacokinetics ,Renal Dialysis ,Internal medicine ,Gram-Negative Bacteria ,medicine ,Humans ,Renal Insufficiency, Chronic ,Dialysis ,Aged ,Retrospective Studies ,Pharmacology ,business.industry ,Retrospective cohort study ,Cephalosporins ,Renal Elimination ,Gram-Negative Bacterial Infections ,business - Abstract
Background In hemodialysis patients, post-dialysis treatment with intravenous antibiotics permits even severe infections to be managed on an outpatient basis. Cefepime is a fourth-generation cephalosporin with a broad spectrum of action in monotherapy. We report on the pharmacokinetics of cefepime in post-dialysis therapy. Methods Since June 2012, twelve infections were treated with post-dialysis cefepime in 9 patients on high-flux hemodialysis. The initial post-dialysis dose of cefepime was approximately 15 mg/kg. The following doses were adapted according to the trough serum levels obtained before the subsequent dialysis in order to be above the EUCAST breakpoints for susceptible organisms and above the MIC90. Residual plasma concentrations were determined before (n = 30) and after (n = 17) dialysis by liquid chromatography–mass spectrometry. Results Overall, the mean ± SD dose of cefepime was 920 ± 270 mg (14.5 ± 5.1 mg/kg), but it was significantly lower before the 48 h interval (775 ± 210 mg or 12.7 ± 4.5 mg/kg) compared to the 72 h interval (1125 ± 225 mg or 17.2 ± 4.9 mg/kg) (p 1 mg/l) with the exception of Pseudomonas aeruginosa (>8 mg/l). Cefepime concentrations were higher in anuric patients compared to those with preserved diuresis (15.6 ± 3.5 vs 9.25 ± 3.6 mg/l; p
- Published
- 2016