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

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dc.contributor.authorMani, Laila-Yasmin
dc.contributor.authorKissling, Sébastien
dc.contributor.authorViceic, Dragana
dc.contributor.authorVogt, Bruno
dc.contributor.authorBurnier, Michel
dc.contributor.authorBuclin, Thierry
dc.contributor.authorRenard, Delphine
dc.date.accessioned2024-10-15T14:16:57Z
dc.date.available2024-10-15T14:16:57Z
dc.date.issued2014-07-23
dc.description.abstractCefepime 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.
dc.description.numberOfPages11
dc.description.sponsorshipUniversitätsklinik für Nephrologie, Hypertonie und Klinische Pharmakologie
dc.description.sponsorshipDepartement Klinische Forschung, Forschungsgruppe Nephrologie / Hypertonie
dc.identifier.doi10.7892/boris.54919
dc.identifier.pmid25052578
dc.identifier.publisherDOI10.1111/hdi.12198
dc.identifier.urihttps://boris-portal.unibe.ch/handle/20.500.12422/125005
dc.language.isoen
dc.publisherWiley-Blackwell
dc.relation.ispartofHemodialysis International
dc.relation.issn1542-4758. 1492-7535
dc.relation.organizationDCD5A442BB17E17DE0405C82790C4DE2
dc.relation.organizationDCD5A442C268E17DE0405C82790C4DE2
dc.subjectHemodialysis
dc.subjectcefepime
dc.subjectdrug-induced adverse event
dc.subjectneurotoxicity
dc.subject.ddc600 - Technology::610 - Medicine & health
dc.titleIntermittent hemodialysis treatment in cefepime-induced neurotoxicity: Case report, pharmacokinetic modeling, and review of the literature
dc.typearticle
dspace.entity.typePublication
dspace.file.typetext
oaire.citation.endPage343
oaire.citation.issue2
oaire.citation.startPage333
oaire.citation.volume19
oairecerif.author.affiliationUniversitätsklinik für Nephrologie, Hypertonie und Klinische Pharmakologie
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oairecerif.author.affiliationDepartement Klinische Forschung, Forschungsgruppe Nephrologie / Hypertonie
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oairecerif.author.affiliation2Universitätsklinik für Nephrologie, Hypertonie und Klinische Pharmakologie
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unibe.description.ispublishedpub
unibe.eprints.legacyId54919
unibe.journal.abbrevTitleHemodialysis International
unibe.refereedTRUE
unibe.subtype.articlejournal

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