Characterizing Cefepime Exposure in an Adolescent on Intermittent Hemodialysis Through Model-Informed Precision Dosing.

Abstract

There are no studies evaluating cefepime pharmacokinetics (PK) in pediatric patients receiving intermittent hemodialysis (iHD). Cefepime dosing in this population is particularly challenging owing to several variables that can affect clearance, including dialysis prescription, residual kidney function, fluid overload, and systemic inflammation. We describe cefepime PK parameters and concentration time profiles in an adolescent male undergoing iHD for whom a cefepime PK consult was requested. Using model-informed precision dosing, we were able to ensure the patient's current dosing of cefepime at 1000 mg daily maintained estimated free cefepime concentrations above 4 times the minimum inhibitory concentration (MIC) for MICs up to ∼4 mg/L while avoiding excessively high trough concentrations. Despite suspicion for increasing residual kidney function, due to increasing urine output, the patient's PK parameters were very similar 4 months later, when an additional consult was requested. This is the first published case describing cefepime PK in an adolescent on iHD and demonstrates the utility of model-informed precision dosing in this population.