Prolonged cefepime infusion reached targets more often in children when the MIC was 1 mg/L or higher

Design

Prospective observational pharmacokinetic study

Population

75 critically ill children, 78 cefepime courses, two paediatric ICUs

Primary outcome

Attainment of 100% fT above 4× MIC

Effect

Optimal exposure 53% vs 59% (p = 0.79); higher target attainment with prolonged infusion at MIC ≥1 mg/L

This prospective observational study in two paediatric intensive care units estimated cefepime exposure using Bayesian forecasting from measured levels in 78 courses (75 children): 19 prolonged infusions and 59 intermittent.

The proportion with optimal exposure (free concentration at least four times the MIC throughout the dosing interval) was similar: 53% with prolonged infusion and 59% with intermittent (p = 0.79). Underexposure was less frequent with prolonged infusion (5% vs 14%) and overexposure more frequent (42% vs 27%), though neither difference was significant. Across simulated MICs, target attainment was similar below 1 mg/L but significantly higher with prolonged infusion at 1 mg/L or above.

For less susceptible organisms such as Pseudomonas, prolonged infusion makes target attainment more likely. The trend to overexposure is a reason to pair it with drug monitoring, given cefepime's neurotoxicity.

• Consider prolonged cefepime infusion in critically ill children when the pathogen MIC is 1 mg/L or higher.
• Measure cefepime levels where available, particularly with prolonged infusion or renal impairment.
• Watch for neurotoxicity (confusion, myoclonus, seizures) when exposure may be high.
• Intermittent dosing remains reasonable for highly susceptible organisms.

Why it matters

Prolonged beta-lactam infusion is increasingly routine in adults, and paediatric exposure data have been thin.

Don't overread it

Small and observational; it measures drug levels, not clinical cure or survival.

The statistics, in plain English

Probability of target attainment is the chance a given regimen reaches the exposure goal. The headline comparison of optimal exposure did not differ; the advantage appeared only for higher MICs, where intermittent dosing struggles.

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