So, I think there still is a safe way for cefepime in clinical practice: ✅ Limited to patients with normal renal function. ✅ As empirical treatment for non-severe cases. ✅ As targeted therapy for low-MIC isolates. Extended-infusion and TDM would probably help in many cases! 🧵(5/5) #IDsky #AMSsky

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The role of anaerobicidal-sparing agents like cefepime could be important in sepsis or immunocompromised hosts with immunotherapy. We are learning how anaerobic microbiota may influence survival, toxicity or cancer response 🧵(4/5) 📚 www.thelancet.com/journals/lan... 📚 ascopubs.org/doi/10.1200/...

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We also have the efficacy question. In my center we use EUCAST for susceptibility testing, whose MIC breakpoints are more restrictive than CLSI’s. So, we use cefepime just for strains with lower MICs than our american colleagues, probably favoring PK/PD target achievement 🧵 (3/5) #IDsky #AMSsky

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Neurotoxicity is definitely an issue for cefepime. But I find it to be very rare among patients with normal renal function and no prior seizure-predisposing conditions. This association was already established in previous metaanalyses 🧵(2/5) academic.oup.com/jac/article/... #IDsky #AMSsky

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I find cefepime very useful to diversify empiric antipseudomonal treatments among immunocompromised hosts, and as a carbapenem-sparing agent against ampC producers. This recent metaanalysis made me wonder if I should stop using it… 🧵(1/5) jamanetwork.com/journals/jam... #IDSky #AMSsky #IDOnc

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