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Fig. 2 | Annals of Intensive Care

Fig. 2

From: Pharmacokinetics, efficacy and tolerance of cefoxitin in the treatment of cefoxitin-susceptible extended-spectrum beta-lactamase producing Enterobacterales infections in critically ill patients: a retrospective single-center study

Fig. 2

Proposed decision and posologic algorithm for cefoxitin use in ICU patients with ESBL-PE infection. *Proposed loading dose and consider measuring the MIC with E-test in this situation. ¤Cefoxitin dosages required for achieving PTA ≥ 90% for target 100% fT>MIC at 48 h, considering the maximal possible value for MIC in this interval of estimation (i.e., 4 mg/L (left) and 8 mg/L (right)). £Considering a continuous RRT and using standard parameters (blood flow rate 250 mL/min, ultrafiltration rate 2000 mL/h). #The computed PTA for CCRIBW = 120 mL/min and a dose of 12 g/24 h was 89.5%, which was rounded to 90% and considered as acceptable. §The use of a dosage of cefoxitin above 12 g/24 h has not been reported so far. The absence of data concerning toxicity and uncertainty considering the possible non-linear PK over such dosage should be kept in mind. CCRIBW creatinine clearance based on ideal body weight, ICU intensive care unit, ESBL-PE extended-spectrum beta-lactamase producing Enterobacterales, fT>MIC proportion of time with free cefoxitin serum concentration over the minimum inhibitory concentration, MIC minimum inhibitory concentration, PK pharmacokinetics, PTA probability of target attainment, TDM therapeutic drug monitoring, RRT renal replacement therapy, ICU intensive care unit

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