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Neurotoxicity Despite a Renal Function-Adjusted Cefepime Regimen: A Case Study
Xavier Engalenc1, Caroline Monchaud2, Naïma Tafzi2
1Médecine Interne, Rhumatologie, Maladies Infectieuses et Tropicales, Brive la Gaillarde, France; and.
Therapeutic Drug Monitoring
|July 4, 2020
Summary
An elderly patient with impaired kidney function experienced cefepime neurotoxicity due to high drug levels. Therapeutic drug monitoring is crucial for adjusting cefepime dosage in such cases.
Area of Science:
- Pharmacology
- Nephrology
- Infectious Diseases
Background:
- A case study involving an 83-year-old male with reduced renal function (eGFR 21 mL/min/1.73 m²).
- The patient was undergoing treatment for a severe bone and joint infection caused by Klebsiella Pneumonia, susceptible to cefepime.
Observation:
- Initial cefepime dosage (1 g twice daily) was based on guidelines for severe infections.
- After one week, the patient developed neurotoxicity with exceptionally high plasma cefepime concentrations.
- Therapeutic drug monitoring (TDM) revealed the need for dose adjustment.
Findings:
- The patient's cefepime dose was reduced eightfold based on TDM results.
- This adjustment successfully managed the neurotoxicity associated with high cefepime levels.
Implications:
- Highlights the critical role of therapeutic drug monitoring for cefepime in patients with compromised renal function.
- Standard cefepime dosing recommendations may not be suitable for patients with altered renal parameters.
- Emphasizes personalized medicine approaches for antibiotic therapy in vulnerable populations.
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