Breakpoints

#124 – Dosing Consult: Cefepime

Breakpoints

Show Notes

Drs. Erin Barreto (@erin_barreto) and Jeffrey Lipman join Dr. Whitney Buckel for a conversation on ideal dosing of cefepime. Hear from the experts on the differences between package insert and “high-dose” regimens, adjustments for renal impairment/augmented renal clearance, and the role of cefepime therapeutic drug monitoring.

References:

Barreto EF, et al. Setting the Beta-Lactam Therapeutic Range for Critically Ill Patients: Is There a Floor or Even a Ceiling? Crit Care Explor. 2021 Jun 11;3(6):e0446.PMID: https://pubmed.ncbi.nlm.nih.gov/34136822/

Barreto EF, et al. Adequacy of cefepime concentrations in the early phase of critical illness: A case for precision pharmacotherapy. Pharmacotherapy. 2023 Nov;43(11):1112-1120. https://pubmed.ncbi.nlm.nih.gov/36648390/

** **Udy AA, et al. Augmented renal clearance: implications for antibacterial dosing in the critically ill. Clin Pharmacokinet. 2010;49(1):1-16. https://pubmed.ncbi.nlm.nih.gov/20000886/

Lipman J, Wallis SC, Boots RJ. Cefepime versus cefpirome: the importance of creatinine clearance. Anesth Analg. 2003 Oct;97(4):1149-1154. doi: 10.1213/01.ANE.0000077077.54084.B0.PMID: 14500173

Roberts JA, Ulldemolins M, Roberts MS, McWhinney B, Ungerer J, Paterson DL, Lipman J. Therapeutic drug monitoring of beta-lactams in critically ill patients: proof of concept. Int J Antimicrob Agents. 2010 Oct;36(4):332-9. doi: 10.1016/j.ijantimicag.2010.06.008. Epub 2010 Aug 3.PMID: 20685085

More from Breakpoints

Sep 20, 2026

Does oseltamivir harm critically ill patients with influenza? In this Breakpoints and Communicable collaboration, Erin McCreary and Josh Davis are joined by Steve Webb and Steve Tong to discuss the REMAP-CAP trial results that are challenging a long-standing intensive care practice. Together, they review the study design, key findings, and implications for clinical care, while highlighting the importance of randomized clinical trials in shaping evidence-based medicine. At the time of recording, the REMAP-CAP results were available as a preprint.

Sep 11, 2026

Dr. Prathit Kulkarni, lead author of a recent state-of-the-art review on acute and chronic bacterial prostatitis, joins host Dr. Erin McCreary to discuss this complex disease state. They walk through diagnosis, epidemiology, treatment, and more. You won’t want to miss this episode!

Aug 21, 2026

Gram-negative resistance is beautifully intricate, scientifically elegant, and very complex. Nothing is more exciting than the recently approved and bursting pipeline of beta-lactamase inhibitors. Listen to Drs. Sam Aitken and Christophe Le Terrier, along with host Dr. Erin McCreary, describe the nuanced enzymology and other antibacterial properties of beta-lactamase inhibitors. This episode also discusses the concepts of stand-alone inhibitors, resistance development, and more. If you want to learn more about sulbactam, clavulanic acid, tazobactam, avibactam, relebactam, vaborbactam, durlobactam, enmetazobactam, zidebactam, nacubactam, ledaborbactam, taniborbactam, and xeruborbactam – this episode is for you!

See all episodes →