Department of Pharmacy, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-Ku, Kumamoto-shi, Kumamoto, Japan; Department of Infection Control, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-Ku, Kumamoto-shi, Kumamoto, Japan.
Department of Infection Control, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-Ku, Kumamoto-shi, Kumamoto, Japan.
J Infect Chemother. 2020 May;26(5):498-501. doi: 10.1016/j.jiac.2019.10.006. Epub 2020 Mar 4.
Cefepime is known to exert bactericidal activity against Pseudomonas aeruginosa. Cefepime-induced neurotoxicity, most likely caused by increased exposure, has recently become a major concern in clinical practice; therefore, appropriate dose reduction of cefepime should be applied with respect to patients with low cefepime clearance (mostly eliminated by the kidneys). Here, we report a case in which Bayesian prediction-based therapeutic drug monitoring (Bayes-TDM) was effectively used to reduce the dose of cefepime in a patient with pneumonia to prevent neurotoxic complications. A woman (age: 59 years, body weight: 32.5 kg, serum creatinine concentration: 1.02 mg/dL) developed pneumonia caused by P. aeruginosa while receiving treatment for scleroderma and systemic lupus erythematosus. She started treatment with a dosing regimen of 1.0 g of cefepime every 8 h (day X). On day X+5, aphasia developed, and the serum cefepime concentration was 71.3 mg/L at trough. This concentration was twice or thrice higher than the reported safe concentration of cefepime (22 or 35 mg/L at trough). Therefore, we reduced the dose of cefepime to 0.5 g every 12 h using Bayes-TDM from day X+7. As a result, the severity of aphasia decreased by day X+10, and this dose was successfully continued up to day X+13 without further adjustment. In conclusion, individualizing doses by Bayes-TDM may be useful in preventing adverse effects associated with cefepime treatment.
头孢吡肟已知对铜绿假单胞菌具有杀菌活性。头孢吡肟诱导的神经毒性，很可能是由于暴露增加所致，最近已成为临床实践中的一个主要关注点；因此，对于头孢吡肟清除率低的患者（主要通过肾脏清除），应适当减少头孢吡肟的剂量。在这里，我们报告了一个病例，该病例通过基于贝叶斯预测的治疗药物监测（Bayes-TDM）有效地降低了肺炎患者的头孢吡肟剂量，以预防神经毒性并发症。一名女性（年龄：59 岁，体重：32.5 kg，血清肌酐浓度：1.02 mg/dL）在接受硬皮病和系统性红斑狼疮治疗时因铜绿假单胞菌引起肺炎。她开始接受 1.0 g 头孢吡肟每 8 小时（第 X 天）的治疗方案。在第 X+5 天，出现了言语障碍，并且在谷浓度时血清头孢吡肟浓度为 71.3 mg/L。该浓度是报道的头孢吡肟安全浓度（22 或 35 mg/L 在谷浓度时）的两倍或三倍。因此，从第 X+7 天开始，我们使用 Bayes-TDM 将头孢吡肟的剂量减少至 0.5 g 每 12 小时。结果，言语障碍的严重程度在第 X+10 天有所减轻，并且该剂量成功地一直持续到第 X+13 天，无需进一步调整。总之，通过 Bayes-TDM 个体化剂量可能有助于预防与头孢吡肟治疗相关的不良反应。
