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29-06-2022 | Pharmacodynamics | Review Article

Clinical Pharmacokinetics and Pharmacodynamics of Cefepime

Authors: Gwendolyn M. Pais, Jack Chang, Erin F. Barreto, Gideon Stitt, Kevin J. Downes, Mohammad H. Alshaer, Emily Lesnicki, Vaidehi Panchal, Maria Bruzzone, Argyle V. Bumanglag, Sara N. Burke, Marc H. Scheetz

Published in: Clinical Pharmacokinetics | Issue 7/2022

Abstract

Cefepime is a broad-spectrum fourth-generation cephalosporin with activity against Gram-positive and Gram-negative pathogens. It is generally administered as an infusion over 30–60 min or as a prolonged infusion with infusion times from 3 h to continuous administration. Cefepime is widely distributed in biological fluids and tissues with an average volume of distribution of ~ 0.2 L/kg in healthy adults with normal renal function. Protein binding is relatively low (20%), and elimination is mainly renal. About 85% of the dose is excreted unchanged in the urine, with an elimination half-life of 2–2.3 h. The pharmacokinetics of cefepime is altered under certain pathophysiological conditions, resulting in high inter-individual variability in cefepime volume of distribution and clearance, which poses challenges for population dosing approaches. Consequently, therapeutic drug monitoring of cefepime may be beneficial in certain patients including those who are critically ill, have life-threatening infections, or are infected with more resistant pathogens. Cefepime is generally safe and efficacious, with a goal exposure target of 70% time of the free drug concentration over the minimum inhibitory concentration for clinical efficacy. In recent years, reports of neurotoxicity have increased, specifically in patients with impaired renal function. This review summarizes the pharmacokinetics, pharmacodynamics, and toxicodynamics of cefepime contemporarily in the setting of increasing cefepime exposures. We explore the potential benefits of extended or continuous infusions and therapeutic drug monitoring in special populations.

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Title: Clinical Pharmacokinetics and Pharmacodynamics of Cefepime
Authors: Gwendolyn M. Pais
Jack Chang
Erin F. Barreto
Gideon Stitt
Kevin J. Downes
Mohammad H. Alshaer
Emily Lesnicki
Vaidehi Panchal
Maria Bruzzone
Argyle V. Bumanglag
Sara N. Burke
Marc H. Scheetz
Publication date: 29-06-2022
Publisher: Springer International Publishing
Keywords: Pharmacodynamics
Pharmacokinetics
Cefepime
Published in: Clinical Pharmacokinetics / Issue 7/2022
Print ISSN: 0312-5963
Electronic ISSN: 1179-1926
DOI: https://doi.org/10.1007/s40262-022-01137-y

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Clinical Pharmacokinetics and Pharmacodynamics of Cefepime

Abstract

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