Case ReportNeurotoxicity Despite a Renal Function-Adjusted Cefepime Regimen: A Case StudyEngalenc, Xavier MD*; Monchaud, Caroline PharmD, PhD†; Tafzi, Naïma MSc†; Woillard, Jean-Baptiste PharmD, PhD†Author Information *Médecine Interne, Rhumatologie, Maladies Infectieuses et Tropicales, Brive la Gaillarde, France; and †Department of Pharmacology and Toxicology, CHU Limoges, Limoges, France. Correspondence: Jean-Baptiste Woillard, PharmD, PhD, University of Limoges, IPPRITT, Limoges F-87000, France (e-mail: email@example.com). The authors declare no conflict of interest. Therapeutic Drug Monitoring: October 2020 - Volume 42 - Issue 5 - p 655-657 doi: 10.1097/FTD.0000000000000786 Buy Metrics Abstract An 83-year-old man, presenting decreased renal function (estimated glomerular filtration rate 21 mL/min/1.73 m2), was treated for a bone and joint infection (on a trans-metatarsal right foot amputation) caused by Klebsiella Pneumonia sensitive to cefepime. The starting dose (1 g bid) was based on recommendations for patients presenting severe infections. One week after treatment initiation, the patient developed neurotoxicity, exhibiting extremely high plasma cefepime concentrations. Based on TDM, the dose was reduced by 8 times the original dose. This case report highlights the importance of therapeutic drug monitoring for cefepime, especially in patients presenting altered renal functions, as typical recommendations are estimated for standard patients. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.