Cefepime Dosing in a Critically Ill Neonate Receiving Continuous Renal Replacement Therapy With the Cardio-Renal Pediatric Dialysis Emergency Machine (CARPEDIEM)

Authors

Cynthia Toy
Grant Stimes
Megan Moore
Poyyapakkam Srivaths
Ayse Akcan Arikan

Publication Date

1-1-2023

Journal

Journal of Pediatric Pharmacology and Therapeutics

DOI

10.5863/1551-6776-28.2.167

PMID

37139247

PMCID

PMC10150901

PubMedCentral® Posted Date

4-26-2023

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

CARPEDIEM, cefepime, continuous renal replacement therapy, dosing, neonate, pharmacodynamics, pharmacokinetics

Abstract

We report on a former 27-week gestational age infant who was placed on the Cardio-Renal Pediatric Dialysis Emergency Machine (CARPEDIEM) at 4 months post-menstrual age while receiving cefepime treatment for an Enterobacter cloacae bacteremia and persistent peritonitis secondary to an infected peritoneal dialysis catheter. Using therapeutic drug monitoring while assessing the clearance of cefepime on continuous renal replacement therapy (CRRT), we were able to successfully treat this patient's infection while also minimizing the risk of side effects from this medication. Current literature supports dosing in adult patients on all modalities of CRRT with effluent flow rates of 20 to 25 mL/kg/hr; however, pharmacokinetic data on cefepime dosing in pediatric CRRT are scant. This case report describes the successful dosing strategy used for this patient while on various rates of continuous veno-venous hemodialysis with CARPEDIEM. Therapeutic drug monitoring of cefepime should be considered in critically ill pediatric patients on CARPEDIEM receiving CRRT.