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

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

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BORIS DOI
10.7892/boris.54919
Date of Publication
July 23, 2014
Publication Type
Article
Division/Institute

Universitätsklinik fü...

Departement Klinische...

Author
Mani, Laila-Yasminorcid-logo
Universitätsklinik für Nephrologie, Hypertonie und Klinische Pharmakologie
Kissling, Sébastien
Viceic, Dragana
Vogt, Bruno
Departement Klinische Forschung, Forschungsgruppe Nephrologie / Hypertonie
Universitätsklinik für Nephrologie, Hypertonie und Klinische Pharmakologie
Burnier, Michel
Buclin, Thierry
Renard, Delphine
Subject(s)

600 - Technology::610...

Series
Hemodialysis International
ISSN or ISBN (if monograph)
1542-4758. 1492-7535
Publisher
Wiley-Blackwell
Language
English
Publisher DOI
10.1111/hdi.12198
PubMed ID
25052578
Uncontrolled Keywords

Hemodialysis

cefepime

drug-induced adverse ...

neurotoxicity

Description
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.
Handle
https://boris-portal.unibe.ch/handle/20.500.12422/125005
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