{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T13:45:21Z","timestamp":1791812721005,"version":"4.3.4"},"reference-count":12,"publisher":"The Pediatric Pharmacy Association","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:p>There are no studies evaluating cefepime pharmacokinetics (PK) in pediatric patients receiving intermittent hemodialysis (iHD). Cefepime dosing in this population is particularly challenging owing to several variables that can affect clearance, including dialysis prescription, residual kidney function, fluid overload, and systemic inflammation. We describe cefepime PK parameters and concentration time profiles in an adolescent male undergoing iHD for whom a cefepime PK consult was requested. Using model-informed precision dosing, we were able to ensure the patient\u2019s current dosing of cefepime at 1000 mg daily maintained estimated free cefepime concentrations above 4 times the minimum inhibitory concentration (MIC) for MICs up to \u223c4 mg\/L while avoiding excessively high trough concentrations. Despite suspicion for increasing residual kidney function, due to increasing urine output, the patient\u2019s PK parameters were very similar 4 months later, when an additional consult was requested. This is the first published case describing cefepime PK in an adolescent on iHD and demonstrates the utility of model-informed precision dosing in this population.<\/jats:p>","DOI":"10.5863\/jppt-25-00130","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T12:50:59Z","timestamp":1791809459000},"page":"675-679","source":"Crossref","is-referenced-by-count":0,"title":["Characterizing Cefepime Exposure in an Adolescent on Intermittent Hemodialysis Through Model-Informed Precision Dosing"],"prefix":"10.5863","volume":"31","author":[{"given":"Shannon","family":"Reinert","sequence":"first","affiliation":[{"name":"Division of Nephrology and Hypertension (SR), Cincinnati Children\u2019s Hospital Medical Center, Division of Translational and Clinical Pharmacology (RMJ), Cincinnati Children\u2019s Hospital Medical Center, Department of Pharmacy (ED), Cincinnati Children\u2019s Hospital Medical Center, Division of Pathology and Laboratory Medicine (EES), Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronaldo","family":"Morales Junior","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension (SR), Cincinnati Children\u2019s Hospital Medical Center, Division of Translational and Clinical Pharmacology (RMJ), Cincinnati Children\u2019s Hospital Medical Center, Department of Pharmacy (ED), Cincinnati Children\u2019s Hospital Medical Center, Division of Pathology and Laboratory Medicine (EES), Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Diseroad","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension (SR), Cincinnati Children\u2019s Hospital Medical Center, Division of Translational and Clinical Pharmacology (RMJ), Cincinnati Children\u2019s Hospital Medical Center, Department of Pharmacy (ED), Cincinnati Children\u2019s Hospital Medical Center, Division of Pathology and Laboratory Medicine (EES), Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin E.","family":"Schuler","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension (SR), Cincinnati Children\u2019s Hospital Medical Center, Division of Translational and Clinical Pharmacology (RMJ), Cincinnati Children\u2019s Hospital Medical Center, Department of Pharmacy (ED), Cincinnati Children\u2019s Hospital Medical Center, Division of Pathology and Laboratory Medicine (EES), Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, OH"},{"name":"Department of Pediatrics (EES), University of Cincinnati College of Medicine, Cincinnati, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. Rhodes","family":"Hambrick","sequence":"additional","affiliation":[{"name":"Division of Nephrology (HRH), Ann and Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, IL"},{"name":"Department of Pediatrics (HRH), Northwestern University Feinberg School of Medicine, Chicago, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonya Tang","family":"Girdwood","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine (STG), CCHMC, Division of Translational and Clinical Pharmacology (STG), CCHMC, Center for Acute Care Nephrology (STG), CCHMC, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3883","reference":[{"issue":"2","key":"JPPT-25-00130-b01","series-title":"Pharmacotherapy","first-page":"220","article-title":"A guide to therapeutic drug monitoring of \u03b2-lactam antibiotics","volume":"41","author":"Fratoni","year":"2021","unstructured":"Fratoni AJ, Nicolau DP, Kuti JL. A guide to therapeutic drug monitoring of \u03b2-lactam antibiotics. Pharmacotherapy. 2021;41(2):220\u2013233."},{"issue":"1","key":"JPPT-25-00130-b02","series-title":"Crit Care","first-page":"123","article-title":"Impact of attaining aggressive vs. conservative PK\/PD target on the clinical efficacy of beta-lactams for the treatment of Gram-negative infections in the critically ill patients: a systematic review and meta-analysis","volume":"28","author":"Gatti","year":"2024","unstructured":"Gatti M, Cojutti PG, Pea F. Impact of attaining aggressive vs. conservative PK\/PD target on the clinical efficacy of beta-lactams for the treatment of Gram-negative infections in the critically ill patients: a systematic review and meta-analysis. Crit Care. 2024;28(1):123."},{"issue":"1","key":"JPPT-25-00130-b03","series-title":"Pharmaceutics","first-page":"53","article-title":"Factors and mechanisms for pharmacokinetic differences between pediatric population and adults","volume":"3","author":"Fernandez","year":"2011","unstructured":"Fernandez E, Perez R, Hernandez A, et al. Factors and mechanisms for pharmacokinetic differences between pediatric population and adults. Pharmaceutics. 2011;3(1):53\u201372."},{"key":"JPPT-25-00130-b04","series-title":"Clin Transl Sci","first-page":"70438","article-title":"Building a beta-lactam model-informed precision dosing service in a quaternary care children\u2019s hospital","volume":"18:e","author":"Girdwood","year":"2015","unstructured":"Girdwood ST, Morales Junior R, Schuler E, et al. Building a beta-lactam model-informed precision dosing service in a quaternary care children\u2019s hospital. Clin Transl Sci. 2015;18:e:70438."},{"issue":"4","key":"JPPT-25-00130-b05","series-title":"Antimicrob Agents Chemother","first-page":"2150","article-title":"Population pharmacokinetic assessment and pharmacodynamic implications of pediatric cefepime dosing for susceptible-dose-dependent organisms","volume":"60","author":"Shoji","year":"2016","unstructured":"Shoji K, Bradley JS, Reed MD, et al. Population pharmacokinetic assessment and pharmacodynamic implications of pediatric cefepime dosing for susceptible-dose-dependent organisms. Antimicrob Agents Chemother. 2016;60(4):2150\u20132156."},{"issue":"4","key":"JPPT-25-00130-b06","series-title":"J Clin Pharmacol","first-page":"565","article-title":"Demonstrating feasibility of an opportunistic sampling approach for pharmacokinetic studies of \u03b2-lactam antibiotics in critically ill children","volume":"61","author":"Tang Girdwood","year":"2021","unstructured":"Tang Girdwood SC, Tang PH, Murphy ME, et al. Demonstrating feasibility of an opportunistic sampling approach for pharmacokinetic studies of \u03b2-lactam antibiotics in critically ill children. J Clin Pharmacol. 2021;61(4):565\u2013573."},{"issue":"7","key":"JPPT-25-00130-b07","series-title":"Clin Pharmacokinet","first-page":"929","article-title":"Clinical pharmacokinetics and pharmacodynamics of cefepime","volume":"61","author":"Pais","year":"2022","unstructured":"Pais GM, Chang J, Barreto EF, et al. Clinical pharmacokinetics and pharmacodynamics of cefepime. Clin Pharmacokinet. 2022;61(7):929\u2013953."},{"issue":"11","key":"JPPT-25-00130-b08","series-title":"J Antimicrob Chemother","first-page":"2908","article-title":"Cefepime-induced neurotoxicity: systematic review","volume":"77","author":"Maan","year":"2022","unstructured":"Maan G, Keitoku K, Kimura N, et al. Cefepime-induced neurotoxicity: systematic review. J Antimicrob Chemother. 2022;77(11):2908\u20132921."},{"issue":"1","key":"JPPT-25-00130-b09","series-title":"J Pharm Pract","first-page":"243","article-title":"Cefepime-associated neurotoxicity in a pediatric patient with stage V chronic kidney disease","volume":"37","author":"Hambrick","year":"2024","unstructured":"Hambrick HR, Pavia K, Tang Girdwood S, et al. Cefepime-associated neurotoxicity in a pediatric patient with stage V chronic kidney disease. J Pharm Pract. 2024;37(1):243\u2013247."},{"issue":"4","key":"JPPT-25-00130-b10","series-title":"Clin Pharmacokinet","first-page":"553","article-title":"Population pharmacokinetics of cefepime in critically ill children and young adults: model development and external validation for Monte Carlo simulations and model-informed precision dosing","volume":"64","author":"Morales Junior","year":"2025","unstructured":"Morales Junior R, Hambrick HR, Mizuno T, et al. Population pharmacokinetics of cefepime in critically ill children and young adults: model development and external validation for Monte Carlo simulations and model-informed precision dosing. Clin Pharmacokinet. 2025;64(4):553\u2013564."},{"issue":"3","key":"JPPT-25-00130-b11","series-title":"Clin Pharmacol Ther","first-page":"268","article-title":"Pharmacokinetics of cefepime in subjects with renal insufficiency","volume":"48","author":"Barbhaiya","year":"1990","unstructured":"Barbhaiya RH, Knupp CA, Forgue ST, et al. Pharmacokinetics of cefepime in subjects with renal insufficiency. Clin Pharmacol Ther. 1990;48(3):268\u2013276."},{"issue":"1","key":"JPPT-25-00130-b12","series-title":"Adv Chronic Kidney Dis","first-page":"93","article-title":"Measurement and estimation of residual kidney function in patients on dialysis","volume":"25","author":"Shafi","year":"2018","unstructured":"Shafi T, Levey AS. Measurement and estimation of residual kidney function in patients on dialysis. Adv Chronic Kidney Dis. 2018;25(1):93\u2013104."}],"container-title":["The Journal of Pediatric Pharmacology and Therapeutics"],"original-title":[],"link":[{"URL":"https:\/\/jppt.kglmeridian.com\/view\/journals\/jppt\/31\/5\/article-p675.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/jppt.kglmeridian.com\/downloadpdf\/journals\/jppt\/31\/5\/article-p675.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/jppt.kglmeridian.com\/downloadpdf\/journals\/jppt\/31\/5\/article-p675.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T12:50:59Z","timestamp":1791809459000},"score":1,"resource":{"primary":{"URL":"https:\/\/jppt.kglmeridian.com\/view\/journals\/jppt\/31\/5\/article-p675.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":12,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.5863\/jppt-25-00130","relation":{},"ISSN":["2331-348X","1551-6776"],"issn-type":[{"value":"2331-348X","type":"electronic"},{"value":"1551-6776","type":"print"}],"subject":[],"published":{"date-parts":[[2026,10]]}}}