A Pilot Study of Cefepime and Meropenem Therapeutic Drug Monitoring in Pediatric Patients on Extracorporeal Therapy.

Abstract

Objective: Patients on extracorporeal therapy receiving medications have the potential for large pharmacokinetic shifts. Data supporting dose adjustments for antibiotics in pediatric patients on extracorporeal membrane oxygenation (ECMO) or continuous renal replacement therapy (CRRT) are limited. Institutional data reveal that cefepime and meropenem troughs are often outside of goal ranges for patients on extracorporeal therapies. The objective of this research was to elucidate potential patterns between clinical characteristics, extracorporeal modalities, and total serum trough concentrations of cefepime and meropenem.

Methods: This retrospective chart review evaluated all patients during the study period with a cefepime or meropenem serum concentration obtained while on ECMO or CRRT. Clinical circumstances were reported, and descriptive statistics were performed on various subgroups to determine which subpopulations experienced more out-of-range drug trough concentrations.

Results: Twenty-one cefepime serum trough concentrations were reviewed for 11 patients, with the mean and median concentrations exceeding the pre-defined goal range. Fifty percent of serum cefepime concentrations from 6 patients on ECMO were supratherapeutic, whereas 92.9% of serum cefepime concentrations from 7 patients on CRRT were supratherapeutic. Seven serum meropenem concentrations were reviewed for 5 patients, and the mean, median, and IQR of the serum troughs were all within goal range, regardless of extracorporeal therapy used. All cefepime and meropenem serum trough concentrations that were collected after a pause in CRRT of at least 1 hour within the previous 24 hours exceeded the goal ranges. One possible neurotoxic event was identified in a patient receiving cefepime and CRRT.

Conclusions: Pharmacists and providers should ensure that pauses in CRRT are accounted for when dosing these antibiotics and should be aware that standard cefepime dosing for these patients often leads to elevated trough concentrations.