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We read with interest the letter from May et al. recently published in Critical Care [1]. The authors suggest that overdosing of β-lactams in 108 critically ill patients receiving renal replacement therapy may not be associated with neurotoxicity. We agree that adequate plasmatic levels of β-lactams in critically ill patients with sepsis should be a primary goal and that under-dosing may put the patient at a dangerous risk of treatment failure [2]. We are, however, concerned about the conclusions of this letter and would like to comment on two points.

Not all β-lactams are equal regarding neurotoxicity