Implementing a Model-Informed Precision Dosing Service for Cefepime in a Quaternary Children's Hospital: A First-Year Experience

Background: This study describes the first-year experience with a model-informed precision dosing (MIPD) consultation service for cefepime at a quaternary children's hospital, including patient characteristics, turnaround times, process barriers, and the impact of dosing recommendations. Methods: This prospective observational study included data from all cefepime MIPD consultations from August 2024 to August 2025. Demographic, clinical, microbiologic, and treatment data were obtained from electronic health records. Timeliness was evaluated by tracking timestamps from consult order to result communication and dose adjustment. The analysis examined whether recommendations led to changes in dose, dosing frequency, or infusion duration. Results: Nineteen patients (median age 2.7 years, range 1 month–27.7 years) received a total of 20 cefepime MIPD consultations. Infection sources included bloodstream, abdomen, respiratory tract, central nervous system, peritoneal dialysis catheter, and urine. Half of the patients required extracorporeal support. Organisms were isolated in 10 patients (cefepime MICs <0.12–8 mg/L), whereas others were dosed empirically. Recommendations were provided a median of 27.8 hours after consultation order (range 6.6–82.4 hours). Eight (40%) recommendations supported continuing the existing regimen, and 10 (50%) resulted in new dosing strategies. In 1 case (5%), cefepime was changed to meropenem owing to concern about possible neurotoxicity, and in another, the family opted for comfort-focused care before recommendations could be provided. Challenges included logistical barriers, communication gaps, insufficient training, system limitations, and clinical issues. Conclusions: These findings support the feasibility and clinical utility of an MIPD consultation service for cefepime. The service enabled timely identification of high or low exposures, including in patients on extracorporeal support, and guided individualized dosing decisions to optimize target attainment.