Vol.73 No.6 November 2025

A case of effective and safe treatment with cefepime administered thrice-weekly after dialysis

Hiroaki Harada¹⁾, Tomohiro Hosoda^{2, 4)}, Shinnosuke Takano^{2, 5)}, Shota Kodaira²⁾, Noritaka Sekiya^{2, 6)}, Soichiro Natsume³⁾, Tatsuya Hajikano¹⁾, Mika Imanishi¹⁾, Yasuhiko Yamamura¹⁾ and Kazuro Ikawa⁷⁾

¹⁾Department of Pharmacy, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, 3-18-22 Hon-Komagome, Bunkyo-ku, Tokyo, Japan
²⁾Department of Infection Prevention and Control, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital
³⁾Department of Colorectal Surgery, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital
⁴⁾Department of Infectious Disease, Kawasaki Municipal Kawasaki Hospital
⁵⁾Department of Nephrology, Tokyo Metropolitan Okubo Hospital
⁶⁾Department of Infectious Disease Emergency Preparedness, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo
⁷⁾Graduate School of Biomedical and Health Sciences, Hiroshima University

Abstract

A 52-year-old man receiving maintenance hemodialysis was admitted to our hospital with a pelvic abscess and sacral osteomyelitis. Blood and pelvic abscess fluid cultures grew Enterobacter cloacae, and the patient was initiated on treatment with cefepime (CFPM) 1 g/day plus metronidazole 750 mg/day. The planned scheduled duration of administration was 12 weeks. The drug was continued after antimicrobial susceptibility testing for E. cloacae indicated no other suitable oral antibiotic options. On hospital day 11, after hemodialysis, the CFPM administration schedule was changed to thrice-weekly administration at the doses of 1.5 g, 1.5 g, and 2 g. The patient's symptoms and inflammatory markers improved, and the patient was discharged on hospital day 29 and he continued to receive outpatient treatment thereafter. However, on post-discharge day 7, the patient was readmitted for a recurrence of the pelvic abscess and sacral osteomyelitis. Blood and the pelvic abscess fluid cultures grew Klebsiella pneumoniae and other bacteria, but not E. cloacae. Subsequent measurements revealed serum CFPM concentrations in the range of 9.2 to 37.1 μg/mL, and no symptoms suggestive of CFPM-related neurotoxicity were observed during the hospitalization. Post-hemodialysis administration of CFPM thrice-weekly has the potential to maintain an effective serum concentration and reduce the length of hospitalization. However, patients should be monitored closely for signs of CFPM-related neurotoxicity.

Key word

cefepime, hemodialysis, pharmacokinetics, serum concentration

Received

April 21, 2025

Accepted

July 1, 2025

Jpn. J. Chemother. 73 (6): 607-613, 2025