PO Box 1488
Warrenville, IL 60555
Phone: 331.248.7888
Email: sidp@affinity-strategies.com
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
Guests
Professor Jeffrey Lipman AM
MBBCh(Wits), DA(SA), FFA(SA), FFA(Crit Care)(SA), FCICM, MD(Research), FISAC, DMed(Res)
Professor Jeffrey Lipman AM, received his medical degree (MBBCh) from the University of Witwatersrand, South Africa and has specialist qualifications in anaesthesia (DA, FFA) and intensive care (FFA Crit Care, FCICM). More recently he received the award of AM – Member of the Order of Australia, for his contribution to Intensive Care.
He recently stepped down from his two positions he held for over 20 years – that of Director of the Intensive Care Services, Royal Brisbane and Womens’ Hospital, as well as Professor and Head of Academy of Critical Care, The University of Queensland. He is the Executive Director of the Burns, Trauma, Critical Care Research Centre at this University. He has Professorial attachments at QUT, University of New South Wales, Chinese University of Hong Kong and his Alma Mater, University of Witwatersrand.
Professor Lipman is a career Intensivist, having worked full-time in Intensive Care Units since 1979. His research interests include all aspects of infection management in intensive care. He has a special interest in the pharmacokinetics of antibiotics, an area in which he completed his MD through the Chinese University of Hong Kong where he still holds an Adjunct Professorial position. More recently has also obtained the DMed(Res) from The University of Queensland on refining beta-lactam dosing in critically ill patients.
He has published over 30 book chapters and over 650 peer-reviewed articles including in high impact journals like NEJM, JAMA and Lancet Infectious Diseases.
Professor Lipman has been the recipient of a number of National and International awards for his service to Intensive Care Medicine and was awarded 2017 Researcher of the Year by Metro North HHS. In 2020 he received his AM. Also in 2020, he was conferred Honorary Membership of European Society of Intensive Care Medicine (only 2nd Australian).
He has set up numerous clinical trials and as Principal Investigator has just published of a randomised clinical trial of 7200 patients with sepsis run in over 100 ICUs in 7 different countries.
He recently stepped down from his two positions he held for over 20 years – that of Director of the Intensive Care Services, Royal Brisbane and Womens’ Hospital, as well as Professor and Head of Academy of Critical Care, The University of Queensland. He is the Executive Director of the Burns, Trauma, Critical Care Research Centre at this University. He has Professorial attachments at QUT, University of New South Wales, Chinese University of Hong Kong and his Alma Mater, University of Witwatersrand.
Professor Lipman is a career Intensivist, having worked full-time in Intensive Care Units since 1979. His research interests include all aspects of infection management in intensive care. He has a special interest in the pharmacokinetics of antibiotics, an area in which he completed his MD through the Chinese University of Hong Kong where he still holds an Adjunct Professorial position. More recently has also obtained the DMed(Res) from The University of Queensland on refining beta-lactam dosing in critically ill patients.
He has published over 30 book chapters and over 650 peer-reviewed articles including in high impact journals like NEJM, JAMA and Lancet Infectious Diseases.
Professor Lipman has been the recipient of a number of National and International awards for his service to Intensive Care Medicine and was awarded 2017 Researcher of the Year by Metro North HHS. In 2020 he received his AM. Also in 2020, he was conferred Honorary Membership of European Society of Intensive Care Medicine (only 2nd Australian).
He has set up numerous clinical trials and as Principal Investigator has just published of a randomised clinical trial of 7200 patients with sepsis run in over 100 ICUs in 7 different countries.
Erin Frazee Barreto, PharmD, PhD, FCCM, FASN
Dr. Erin Barreto is an Associate Professor of Medicine and Pharmacy at Mayo Clinic, and a pharmacist scientist with a practice in critical care. Dr. Barreto has received funding from NIAID, AHRQ, foundations, and industry. She has authored or co-authored more than 150 peer-reviewed manuscripts and book chapters and is a recognized expert in optimizing the safe and effective use of renally-active medications. She is the principal investigator of the BLOOM Project, a broad effort designed to bring personalized beta-lactam therapy to the care of acutely ill patients, and the co-chair of the IBLICS effort – the forthcoming International Beta-Lactam Individualization Consensus Statement.
This episode sounds like a must-listen for anyone involved in critical care pharmacotherapy. I appreciate how it dives into the nuances of cefepime dosing—especially the balance between package insert recommendations and the “high-dose” regimens that are sometimes needed in critically ill patients. The discussion around renal function and augmented renal clearance is particularly valuable since those factors are often overlooked but crucial for patient safety. Having experts like Dr. Barreto and Professor Lipman share their insights on therapeutic drug monitoring really brings precision medicine to life. It’s great to see such a thoughtful, evidence-based approach to antibiotic optimization.