The stability of cefepime during simulated continuous infusion was determined with a motorized portable infusion pump worn over a period of 24 to 36 h. Susceptibility testing on cefepime solutions over time indicates that the degradation products do not exhibit antibacterial activity. Cefepime stability at 24 h following continuous infusion was 94.3% ؎ 1.0%, which supports the use of continuous infusion.Continuous infusion (CI) is an efficient means of administering beta-lactams to maintain drug concentrations higher than the MIC throughout the dosing interval. Results from a number of clinical trials shows similar efficacy at a reduced dose (10,12,15). Thus, CI has a pharmacoeconomic advantage over intermittent dosing by achieving the same effect with a lower daily dose of drug (2, 6).In order to support CI of a drug, it is necessary to establish that the desired drug is stable throughout the administration period. Previous studies indicate that cefepime is stable for 24 h at room temperature (4); however, cefepime is not stable for 24 h at body temperature (13). The temperature and stability of cefepime administered with motorized portable infusion pumps are presently unknown. The purpose of this study is to determine if cefepime can be administered via CI with a motorized portable infusion pump and to define optimal conditions for storage prior to administration. In addition, the major breakdown products of cefepime will be identified and their antibacterial activity will be characterized.Methods and experimental design. The high-performance liquid chromatography procedures utilized were based on a modification of a previously published cefepime assay (3). In brief, an analytical reversed-phase C 18 column (250 by 4.6 mm; J&W Scientific) with 4.6-mm diameter particles was used to separate the various compounds found in the admixed drug solution. The column was connected onto a Hitachi L-6200 Intelligent pump, and the elutants were monitored at the cefepime absorption UV peak at 260 nm (9). The mobile phase consisted of 8% (vol/vol) acetonitrile in 20 mM ammonium acetate, adjusted to pH 4.9. The samples were kept at 4°C with a temperature-controlled water jacket. Sample concentrations were analyzed in duplicate. None of the degradation products interfered with the cefepime peak. The standard curve had a linear range from 25 to 250 g/ml, with a correlation coefficient that was Ͼ 0.999. The intraday coefficients of variation measured in triplicate ranged from 0.05 to 1.15%, and interday during the 23 analytical days ranged from 1.33 to 3.48%. The assay lower limit of detection was 25 g/ml, with a coefficient of variation of 0.54%. CI cefepime was simulated by using a portable infusion pump (Microject 30; Sorenson Medical, West Jordan, Utah). The pump and the admixed solution (MediBag, ethylene vinyl acetate, 250 ml; Sorenson Medical) were placed inside individual pouches of a light protective bag worn on a belt. The drug solution was pumped through a cassette (Microject cassette and filter; Sorenson Medical) and...