Multiple-dose pharmacokinetics of cefepime in long-term hemodialysis with high-flux membranes

Abstract

Objective: Among uremic patients on hemodialysis, infectious complications leading to a high incidence of morbidity and mortality are a well-documented problem. In this multi-dose study, the safety, tolerance, and pharmacokinetics of cefepime during high-flux hemodialysis were investigated and an improved dosing schedule is presented.

Methods: Six long-term hemodialysis patients received 2 g cefepime i.v. at the end of hemodialysis three times per week.

Results: Trough levels of cefepime were 23.3 ± 7.3 mg/l and peak serum concentrations 165.6 ± 48.7 mg/l. After 3.5 h of high-flux hemodialysis, 72.2 ± 6.4% of cefepime was eliminated. The intradialytic half-life was 1.6 ± 0.29 h and the interdialytic half-life 22.0 ± 2.14 h.

Conclusion: A dosage of 2 g cefepime after each hemodialysis session achieved drug levels well above the minimal inhibitory concentration (MIC)₉₀ for most of the target pathogens. Thus, the described dosing schedule is an efficient and cost saving antmicrobial therapy for severe infections in long-term hemodialysis patients with no residual renal function.