Continuous versus intermittent infusion of cefepime in neurosurgical patients with post-operative intracranial infections

Cefepime is administered as an intermittent infusion (II); however, continuous infusion (CI) may be advantageous because beta-lactam antibiotics exhibit time-dependent antibacterial activity. This retrospective, non-randomised, comparative study included 68 neurosurgical patients with post-operative intracranial infections treated with 4 g/day cefepime over 24 h as a CI (n = 34) or 2 g every 12 h as II (n = 34). CI controlled the intracranial infection more rapidly and effectively than II (6.6 +/- 1.9 days vs. 7.8 +/- 2.6 days; P = 0.036). By considering the minimum inhibitory concentrations (MICs) to be 4 mu g/mL and 8 mu g/mL, the percentage of time when the cefepime plasma or CSF concentrations were higher than the MIC (% T->MIC) was calculated for each patient. For plasma cefepime concentrations, the % T->MIC in the CI group was higher than in the II group (for MICs of 8 mu g/mL, 100% vs. 75%, respectively). The mean calculated area under the curve (AUC) in the CI group was similar to the II group (1197.99 +/- 72.15 mu g h/mL vs. 890.84 +/- 140.78 mu g h/mL; P = 0.655). For CSF cefepime concentrations, the % T->MIC in the CI group was higher than in the II group (for MICs of 4 mu g/mL and 8 mu g/mL, 83.3% and 75% vs. 25% and 0%, respectively). The mean calculated AUC for the CI group was higher than the II group (220.56 +/- 13.59 mu g h/mL vs. 86.34 +/- 5.69 mu g h/mL; P = 0.003). Therefore, CI of cefepime significantly enhanced the antibacterial effect and reduced the treatment duration in neurosurgical patients with post-operative intracranial infections. (C) 2013 Elsevier B. V. and the International Society of Chemotherapy. All rights reserved.