Adequacy of high-dose cefepime regimen in febrile neutropenic patients with hematological malignancies

Sime, Fekade Bruck., Roberts, Michael S., Tiong, Ing Soo., Gardner, Julia H., Lehman, Sheila., Peake, Sandra L., Hahn, Uwe., Warner, Morgyn S. and Roberts, Jason A. (2015) Adequacy of high-dose cefepime regimen in febrile neutropenic patients with hematological malignancies. Antimicrobial Agents and Chemotherapy, 59 9: 5463-5469. doi:10.1128/AAC.00389-15

Attached Files (Some files may be inaccessible until you login with your UQ eSpace credentials)
Name Description MIMEType Size Downloads
UQ369238_OA.pdf Full text (open access) application/pdf 343.32KB 0

Author Sime, Fekade Bruck.
Roberts, Michael S.
Tiong, Ing Soo.
Gardner, Julia H.
Lehman, Sheila.
Peake, Sandra L.
Hahn, Uwe.
Warner, Morgyn S.
Roberts, Jason A.
Title Adequacy of high-dose cefepime regimen in febrile neutropenic patients with hematological malignancies
Journal name Antimicrobial Agents and Chemotherapy   Check publisher's open access policy
ISSN 1098-6596
Publication date 2015-09
Year available 2015
Sub-type Article (original research)
DOI 10.1128/AAC.00389-15
Open Access Status File (Publisher version)
Volume 59
Issue 9
Start page 5463
End page 5469
Total pages 7
Place of publication Washington, United States
Publisher American Society for Microbiology
Collection year 2016
Language eng
Formatted abstract
While guidelines recommend empirical cefepime therapy in febrile neutropenia, the mortality benefit of cefepime has been controversial. In light of this, recent reports on pharmacokinetic changes for several antibiotics in febrile neutropenia and the consequent suboptimal exposure call for a pharmacokinetic/pharmacodynamic evaluation of current dosing. This study aimed to assess pharmacokinetic/pharmacodynamic target attainment from a 2-g intravenous (i.v.) every 8 h (q8h) cefepime regimen in febrile neutropenic patients with hematological malignancies. Cefepime plasma concentrations were measured in the 3rd, 6th, and 9th dosing intervals at 60% of the interval and/or trough point. The selected pharmacokinetic/pharmacodynamic targets were the proportion of the dosing interval (60% and 100%) for which the free drug concentration remains above the MIC (fT>MIC). Target attainment was assessed in reference to the MIC of isolated organisms if available or empirical breakpoints if not. The percentage of fT>MIC was also estimated by log-linear regression analysis. All patients achieved >60% fT>MIC in the 3rd and 6th dosing intervals. A 100% fT>MIC was not attained in 6/12, 4/10, and 4/9 patients in the 3rd, 6th, and 9th dose intervals, respectively, or in 14/31 (45%) of the dosing intervals investigated. On the other hand, 29/31 (94%) of trough concentrations were at or above 4 mg/liter. In conclusion, for patients with normal renal function, a high-dose 2-g i.v. q8h cefepime regimen appears to provide appropriate exposure if the MIC of the organism is ≤4 mg/liter but may fail to cover less susceptible organisms.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Medicine Publications
School of Pharmacy Publications
 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 2 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 2 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Tue, 15 Sep 2015, 00:23:00 EST by System User on behalf of Scholarly Communication and Digitisation Service