Intermittent hemodialysis treatment in cefepime-induced neurotoxicity: Case report, pharmacokinetic modeling, and review of the literature.

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State: Public
Version: Final published version
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Serval ID
serval:BIB_95626566C721
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Intermittent hemodialysis treatment in cefepime-induced neurotoxicity: Case report, pharmacokinetic modeling, and review of the literature.
Journal
Hemodialysis International. International Symposium On Home Hemodialysis
Author(s)
Mani L.Y., Kissling S., Viceic D., Vogt B., Burnier M., Buclin T., Renard D.
ISSN
1542-4758 (Electronic)
ISSN-L
1492-7535
Publication state
Published
Issued date
07/2015
Peer-reviewed
Oui
Volume
19
Number
2
Pages
333-343
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Cefepime is a broad-spectrum cephalosporin indicated for in-hospital treatment of severe infections. Acute neurotoxicity, an increasingly recognized adverse effect of this drug in an overdose, predominantly affects patients with reduced renal function. Although dialytic approaches have been advocated to treat this condition, their role in this indication remains unclear. We report the case of an 88-year-old female patient with impaired renal function who developed life-threatening neurologic symptoms during cefepime therapy. She was treated with two intermittent 3-hour high-flux, high-efficiency hemodialysis sessions. Serial pre-, post-, and peridialytic (pre- and postfilter) serum cefepime concentrations were measured. Pharmacokinetic modeling showed that this dialytic strategy allowed for serum cefepime concentrations to return to the estimated nontoxic range 15 hours earlier than would have been the case without an intervention. The patient made a full clinical recovery over the next 48 hours. We conclude that at least 1 session of intermittent hemodialysis may shorten the time to return to the nontoxic range in severe clinically patent intoxication. It should be considered early in its clinical course pending chemical confirmation, even in frail elderly patients. Careful dosage adjustment and a high index of suspicion are essential in this population.
Pubmed
Web of science
Create date
03/12/2014 17:34
Last modification date
11/06/2020 6:21
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