Breakpoints #124 – Dosing Consult: Cefepime
Oct 10, 2025
Joining Dr. Whitney Buckel are Erin Barreto, an Associate Professor at Mayo Clinic and expert in personalized beta-lactam therapy, and Jeffrey Lipman, an intensivist renowned for his work on antibiotic pharmacokinetics. They dive into cefepime dosing, discussing why traditional package insert guidelines fall short for critically ill patients. The experts advocate for higher dosing strategies, explore augmented renal clearance implications, and emphasize the importance of therapeutic drug monitoring for individualized patient care.
AI Snips
Chapters
Transcript
Episode notes
Limitations Of Creatinine-Based GFR
- Creatinine-based estimations lag true renal function and can mislead dosing during rapid physiologic changes.
- Measured creatinine clearance or emerging GFR methods give more actionable, real-time data.
Recognize Augmented Renal Clearance
- Augmented renal clearance (ARC) arises from hyperdynamic circulation in young or trauma patients and increases renal drug elimination.
- ARC can raise GFR well above normal, causing subtherapeutic beta-lactam levels if not accounted for.
Prefer Prolonged Or Continuous Infusion
- Use prolonged (extended) or continuous infusion to maximize time above MIC for severe gram-negative infections.
- Always give a loading bolus before starting extended or continuous infusion.