Cefepime exposure in prolonged or intermittent infusion in critically ill children
Abstract
Aims Cefepime is commonly used in critically ill children for whom there is a high between‐subject variability. To reach the therapeutic pharmacokinetic (PK) target in critically ill patients, prolonged infusion of beta‐lactams seems to be the most efficient. The aim of this study was to compare cefepime exposure between prolonged and intermittent infusions in critically ill children. Methods This prospective observational study was conducted in two paediatric intensive care units. Children with a cefepime plasma concentration measurement were included. Steady‐state free residual and plateau concentrations were estimated using Bayesian forecasting. The PK target was defined as 100% f T ≥4xMIC . Exposure was compared using the minimum inhibitory concentrations (MICs) of the pathogens identified in the patients. The probability of target attainment (PTA) was also compared using various MICs. Results Seventy‐eight antibiotic courses in 75 patients were included, divided into 19 prolonged infusions and 59 intermittent infusions. Prolonged and intermittent infusions were comparable for optimal exposure ( n = 10/19, 53% vs. n = 35/59, 59%, p = .79). Overexposure tended to be more frequent with prolonged infusion ( n = 8/19, 42% vs. n = 16/59, 27%, p = .26), whereas underexposure tended to be less common with prolonged infusion ( n = 1/19, 5% vs. n = 8/59, 14%, p = .44). Considering the wide range of MICs, the PTA was comparable for MIC < 1 mg/L but was significantly higher for prolonged infusion for MIC ≥ 1 mg/L ( p < .05). Conclusion Prolonged infusion of cefepime provides a higher PTA when MIC is ≥1 mg/L compared with intermittent infusion. This result suggests the superiority of prolonged infusion for high MIC bacteria.
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BibTeX
@article{hobeika2026cefepime,
title = {{Cefepime exposure in prolonged or intermittent infusion in critically ill children}},
author = {Marc Hobeika and Deborah Hirt and Emmanuelle Bille and Sihem Benaboud and Julie Toubiana and Pierre‐louis Léger and Jérôme Rambaud and Agathe Béranger and Delphine Callot and Sylvain Renolleau and Jean‐marc Treluyer and Mehdi Oualha and Noémie de Cacqueray},
journal = {British Journal of Clinical Pharmacology},
year = {2026},
month = sep,
doi = {10.1002/bcp.70804},
url = {https://hal.science/hal-05792898v1},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Cefepime exposure in prolonged or intermittent infusion in critically ill children
AU - Marc Hobeika
AU - Deborah Hirt
AU - Emmanuelle Bille
AU - Sihem Benaboud
AU - Julie Toubiana
AU - Pierre‐louis Léger
AU - Jérôme Rambaud
AU - Agathe Béranger
AU - Delphine Callot
AU - Sylvain Renolleau
AU - Jean‐marc Treluyer
AU - Mehdi Oualha
AU - Noémie de Cacqueray
PY - 2026
DA - 2026/09/10
JO - British Journal of Clinical Pharmacology
DO - 10.1002/bcp.70804
UR - https://hal.science/hal-05792898v1
AB - Aims Cefepime is commonly used in critically ill children for whom there is a high between‐subject variability. To reach the therapeutic pharmacokinetic (PK) target in critically ill patients, prolonged infusion of beta‐lactams seems to be the most efficient. The aim of this study was to compare cefepime exposure between prolonged and intermittent infusions in critically ill children. Methods This prospective observational study was conducted in two paediatric intensive care units. Children with a cefepime plasma concentration measurement were included. Steady‐state free residual and plateau concentrations were estimated using Bayesian forecasting. The PK target was defined as 100% f T ≥4xMIC . Exposure was compared using the minimum inhibitory concentrations (MICs) of the pathogens identified in the patients. The probability of target attainment (PTA) was also compared using various MICs. Results Seventy‐eight antibiotic courses in 75 patients were included, divided into 19 prolonged infusions and 59 intermittent infusions. Prolonged and intermittent infusions were comparable for optimal exposure ( n = 10/19, 53% vs. n = 35/59, 59%, p = .79). Overexposure tended to be more frequent with prolonged infusion ( n = 8/19, 42% vs. n = 16/59, 27%, p = .26), whereas underexposure tended to be less common with prolonged infusion ( n = 1/19, 5% vs. n = 8/59, 14%, p = .44). Considering the wide range of MICs, the PTA was comparable for MIC < 1 mg/L but was significantly higher for prolonged infusion for MIC ≥ 1 mg/L ( p < .05). Conclusion Prolonged infusion of cefepime provides a higher PTA when MIC is ≥1 mg/L compared with intermittent infusion. This result suggests the superiority of prolonged infusion for high MIC bacteria.
SN - 0306-5251
SN - 1365-2125
ER -