ArticleJournal of intensive care2024
Monte Carlo simulations of cefepime in children receiving continuous kidney replacement therapy support continuous infusions for target attainment.
Article in Journal of intensive care, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Implementing a Model-Informed Precision Dosing Service for Cefepime in a Quaternary Children's Hospital: A First-Year Experience.Therapeutic drug monitoring · 2026Article
- Antimicrobial pharmacokinetics in pediatric patients on kidney replacement therapy: a comprehensive narrative review.Pediatric nephrology (Berlin, Germany) · 2026Review
- The case for combined pediatric nephrology and clinical pharmacology training.Pediatric nephrology (Berlin, Germany) · 2026Article
- Urine NGAL adds to serum creatinine in predicting cefepime clearance in critically ill children at high risk of acute kidney injury.International journal of antimicrobial agents · 2026Article
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Authors and funding
6 authors.
Funding
Abstract
backgroundSepsis 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.
methodsWe 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 m
resultsAssuming 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.
conclusionsOur 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.
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