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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
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Target-Controlled Infusion of Cefepime in Critically Ill Patients
Stijn Jonckheere1,2,3, Nikolaas De Neve4, Jan Verbeke4
1Department of Clinical Microbiology, OLV Hospital, Aalst, Belgium stijn.jonckheere@yperman.net.
Antimicrobial Agents and Chemotherapy
|November 6, 2019
Summary
Target-controlled infusion (TCI) optimizes cefepime dosing in critically ill patients. This pharmacokinetic-pharmacodynamic approach improves drug delivery, enhancing antimicrobial treatment efficacy in intensive care units.
Area of Science:
- Pharmacology
- Critical Care Medicine
- Clinical Pharmacy
Background:
- Achieving appropriate pharmacokinetic-pharmacodynamic (PK-PD) targets for cefepime in critically ill patients is challenging due to its narrow therapeutic-toxic window.
- Target-controlled infusion (TCI) systems have proven effective for precise drug delivery in anesthesia.
Purpose of the Study:
- To investigate the performance of TCI for cefepime target attainment in intensive care unit (ICU) patients.
- To evaluate the accuracy of TCI in maintaining desired cefepime plasma concentrations.
Main Methods:
- A clinical trial involving 21 ICU patients treated with cefepime via TCI.
- TCI utilized a population PK model with creatinine clearance (Cockcroft-Gault) to guide cefepime infusion.
- Measured cefepime concentrations were compared to a target of 16 mg/liter using ultraperformance liquid chromatography-tandem mass spectrometry.
Main Results:
- 50.3% of measured cefepime concentrations fell within ±30% of the 16 mg/liter target.
- The TCI system demonstrated a median performance error (MdPE) of 21.1% and a median absolute performance error (MdAPE) of 32.0%.
Conclusions:
- TCI is a valuable tool for optimizing cefepime dosage in ICU patients.
- The TCI system shows promise for improving cefepime delivery and achieving PK-PD targets in critical care settings.
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