Document Type
Article
Publication Date
10-8-2024
Identifier
DOI: 10.1186/s40560-024-00752-0; PMCID: PMC11459894
Abstract
BACKGROUND: Sepsis is a leading cause of acute kidney injury requiring continuous kidney replacement therapy (CKRT) and CKRT can alter drug pharmacokinetics (PK). Cefepime is used commonly in critically ill children and is cleared by CKRT, yet data regarding cefepime PK and pharmacodynamic (PD) target attainment in children receiving CKRT are scarce, so we performed Monte Carlo simulations (MCS) of cefepime dosing strategies in children receiving CKRT.
METHODS: We developed a CKRT "module" in the precision dosing software Edsim++. The module was added into a pediatric cefepime PK model. 1000-fold MCS were performed using six dosing strategies in patients aged 2-25 years and ≥ 10 kg with differing residual kidney function (estimated glomerular filtration rate of 5 vs 30 mL/min/1.73 m2 vs high-dose of 8000 mL/h/1.73 m2), and fluid accumulation (0-30%). Probability of target attainment (PTA) was defined by percentage of patients with free concentrations exceeding bacterial minimum inhibitory concentration (MIC) for 100% of the dosing interval (100% fT > 1xMIC) and 4xMIC using an MIC of 8 mg/L for Pseudomonas aeruginosa.
RESULTS: Assuming standard-dose dialysis and minimal kidney function, > 90% PTA was achieved for 100% fT > 1x MIC with continuous infusions (CI) of 100-150 mg/kg/day (max 4/6 g) and 4-h infusions of 50 mg/kg (max 2 g), but > 90% PTA for 100% fT > 4x MIC was only achieved by 150 mg/kg CI. Decreased PTA was seen with less frequent dosing, shorter infusions, higher-dose CKRT, and higher residual kidney function.
CONCLUSIONS: Our new CKRT-module was successfully added to an existing cefepime PK model for MCS in young patients on CKRT. When targeting 100% fT > 4xMIC or using higher-dose CKRT, CI would allow for higher PTA than intermittent dosing.
Journal Title
J Intensive Care
Volume
12
Issue
1
First Page
38
Last Page
38
Keywords
Beta-lactam pharmacokinetics; CKRT; Pediatric acute kidney injury
Recommended Citation
Hambrick HR, Punt N, Pavia K, Mizuno T, Goldstein SL, Tang Girdwood S. Monte Carlo simulations of cefepime in children receiving continuous kidney replacement therapy support continuous infusions for target attainment. J Intensive Care. 2024;12(1):38. Published 2024 Oct 8. doi:10.1186/s40560-024-00752-0
Comments
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Publisher's Link: https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-024-00752-0