Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Prospective monitoring of cefepime in intensive care unit adult patients. | Chapuis et al. Critical Care 2010 14 R51 http content 14 2 R51 RESEARCH Open Access Prospective monitoring of cefepime in intensive care unit adult patients Thomas M Chapuis1 3 Eric Giannoni2 Paul A Majcherczyk3 René Chioléro4 Marie-Denise Schaller4 Mette M Berger4 Saskia Bolay3 Laurent A Décosterd5 Denis Bugnon3 and Philippe Moreillon 3 Abstract Introduction Cefepime has been associated with a greater risk of mortality than other beta-lactams in patients treated for severe sepsis. Hypotheses for this failure include possible hidden side-effects for example neurological or inappropriate pharmacokinetic pharmacodynamic PK PD parameters for bacteria with cefepime minimal inhibitory concentrations MIC at the highest limits of susceptibility 8 mg l or intermediate-resistance 16 mg l for pathogens such as Enterobacteriaceae Pseudomonas aeruginosa and Staphylococcus aureus. We examined these issues in a prospective non-interventional study of 21 consecutive intensive care unit ICU adult patients treated with cefepime for nosocomial pneumonia. Methods Patients median age years range to received intravenous cefepime at 2 g every 12 hours for creatinine clearance CLCr 50 ml min and 2 g every 24 hours or 36 hours for CLCr 50 ml minute. Cefepime plasma concentrations were determined at several time-points before and after drug administration by high-pressure liquid chromatography. PK PD parameters were computed by standard non-compartmental analysis. Results Seventeen first-doses and 11 steady states that is four to six days after the first dose were measured. Plasma levels varied greatly between individuals from two- to three-fold at peak-concentrations to up to 40-fold at troughconcentrations. Nineteen out of 21 90 patients had PK PD parameters comparable to literature values. Twenty-one of 21 100 patients had appropriate duration of cefepime concentrations above the MIC T MIC 50 for the pathogens recovered in this study MIC 4 mg l but only 45 to
