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Updated: Aug 6, 2026

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
11:17

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

Published on: August 30, 2018

Evaluation of Model-Informed Precision Dosing of Cefepime in Critically Ill Patients: A French Before-After Study

Giuseppe Balice1,2, Soizic Percevault3, Sabine Cohen4

  • 1Université Claude Bernard Lyon 1, Laboratoire de Biométrie et Biologie Evolutive, CNRS UMR5558, Villeurbanne, France.

Therapeutic Drug Monitoring
|July 20, 2026
PubMed
Abstract

Insights

Model-informed precision dosing (MIPD) for cefepime in intensive care units reduces overexposure risks. This approach may enhance achieving therapeutic drug levels, though further clinical research is needed.

Area of Science:

  • Pharmacology
  • Critical Care Medicine
  • Infectious Diseases

Background:

  • Cefepime is crucial for treating gram-negative infections in ICUs.
  • Its neurological toxicity necessitates therapeutic drug monitoring.
  • Model-informed precision dosing (MIPD) is a potential strategy for optimizing cefepime therapy.

Purpose of the Study:

  • To compare cefepime dosing optimization using MIPD versus empirical therapeutic drug monitoring.
  • To evaluate the impact of MIPD on achieving target cefepime plasma concentrations (Cmin).

Main Methods:

  • Retrospective before-after study of 254 ICU patients receiving cefepime.
  • Comparison of empirical dosing with MIPD-guided dosing.
  • Analysis of cefepime trough concentrations (Cmin) to assess target attainment (4 × MIC to 20 mg/L).

Main Results:

  • MIPD was associated with a nonsignificant increase in achieving therapeutic concentrations (aOR 1.38).
  • MIPD significantly reduced the odds of cefepime overexposure (aOR 0.59).
  • Hazard ratios for target attainment were 1.1 on day 1 and 1.6 on day 7.

Conclusions:

  • Cefepime MIPD in ICUs lowers overexposure risk compared to empirical dosing.
  • MIPD shows potential for improving pharmacokinetic/pharmacodynamic target attainment.
  • Further studies on clinical outcomes are required to confirm MIPD's added value.
Keywords:
cefepimeintensive caremodel-informed precision dosing

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