Background Drug shortages may negatively impact outcomes in hospitalized patients. A cefepime dosing regimen of 1 gram every 6 hours (1 g q6h) has shown to provide similar exposures above target minimum inhibitory concentrations compared to the regimen of 2 g q8h approved by the United States Food and Drug Administration (FDA) for febrile neutropenia. Our objective was to determine if the dosing regimen of 1 g q6h amidst a cefepime shortage is an appropriate alternative for the treatment of febrile neutropenia. Methods A retrospective chart review of hospitalized patients who received cefepime for febrile neutropenia over a two-year period was performed. Patients were grouped based on cefepime dosing strategy: 2 g q8h vs. 1 g q6h. The primary objective was to compare time to defervescence after cefepime initiation. Secondary objectives included all-cause 30-day mortality, duration of antibiotic therapy, and inpatient length of stay. Results Seventy-five patients in each arm were included. There were no differences in baseline age or severity of illness between groups. There was no difference in the primary objective as median time to defervescence was similar between the 2 g q8h and 1 g q6h groups (69.0 vs. 65.3 h: p= 0.67). Additionally, no differences were found in the secondary objectives of all-cause 30-day mortality (10.7% vs. 9.3%: p = 0.79), duration of therapy (80.8 vs. 88.0 h: p = 0.34), or length of stay (9 vs. 7 days: p = 0.50). Conclusions Our study identified no differences in clinical outcomes with cefepime 1 g q6h compared to the traditional FDA-approved 2 g q8h regimen for the treatment of febrile neutropenia.

Background: Atrial fibrillation (AF) frequently develops during critical illness. In septic shock complicated by rapid AF, the use of phenylephrine may be advantageous secondary to its β-1 sparing properties. However, evidence supporting this strategy is lacking. Objective: The purpose of this study is to determine the clinical effect on rate control of transitioning norepinephrine to phenylephrine in septic shock patients who develop AF with a rapid ventricular response (RVR). Methods: A single-center retrospective study of septic shock patients admitted to the medical or surgical intensive care unit (ICU) who developed AF with RVR (heart rate >110 beats per minute [bpm]). Patients who were switched to phenylephrine were compared to those who remained on norepinephrine. The primary end point was sustained achievement of rate control. A time-varying Cox proportional hazards model was used to assess the primary end point. Results: A total of 67 patients were included in the study, of which 28 were switched to phenylephrine. Baseline characteristics were similar between groups. The unadjusted hazard ratio for achieving rate control was significant at 1.99 (95% confidence interval [CI]: 1.19-3.34; P < .01) for the phenylephrine group. The adjusted hazard ratio was 1.75 (95% CI: 0.86-3.53; P = .12). There were no statistically significant differences in mortality or ICU length of stay. Conclusion: Our study suggests a potential clinical effect on achieving rate control when switching to phenylephrine cannot be excluded. It remains unclear if there is a benefit on mortality or length of stay outcomes in critically ill patients.

BackgroundA cefepime dosing regimen of 1 g every 6 hours (1 g Q6h) has shown to provide similar exposure above the target minimum inhibitory concentration than the higher FDA-approved regimen of 2 g Q8h for febrile neutropenia. We hypothesize clinical outcomes among patients receiving either dosing strategy will be similar.MethodsA retrospective chart review of hospitalized patients who received cefepime for documented febrile neutropenia over a two-year period was performed. Patients were grouped based on cefepime dosing strategy: 1 g Q6h vs. 2 g Q8h. The primary objective was to compare time to defervescence after cefepime initiation. Secondary objectives looked at all-cause and infection-related 30-day mortality, duration of therapy, and length of stay (LOS).ResultsSeventy-five patients in each arm were included. There were no differences in baseline age or severity of illness between groups. There was no difference in the primary objective as average time to defervescence was similar between the 1 g Q6h and 2 g Q8h groups (85.9 hours vs. 89.7 hours: P = 0.206), respectively. Additionally, no differences were found in the secondary objectives including all-cause 30-day mortality (6.7% vs. 9.3%: P = 0.547), duration of therapy (95.7 hours vs. 99.1 h: P = 0.174), or LOS (9 vs. 7 days: P = 0.251).ConclusionThe regimen of cefepime 1 g Q6h provides similar clinical outcomes as the traditional FDA-approved 2 g Q8h regimen in the treatment of febrile neutropenia. The lower total daily dose will result in less drug exposure and a potential decreased risk of cefepime-related adverse drug events. Disclosures All authors: No reported disclosures.

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