Can You Give IM Cefepime?
Yes, cefepime can be administered intramuscularly, but only for mild to moderate uncomplicated or complicated urinary tract infections (UTIs) due to E. coli in adults. 1
Approved IM Indications and Dosing
According to FDA labeling, the intramuscular route is highly restricted:
- Only indication: Mild to moderate uncomplicated or complicated UTIs (including pyelonephritis) caused by E. coli
- Dose: 0.5 to 1 g IM every 12 hours
- Duration: 7-10 days
- Patient population: Adults with creatinine clearance >60 mL/min 1
Critical Limitations
For all other infections, cefepime must be given intravenously, including:
- Pneumonia (moderate to severe)
- Febrile neutropenia
- Severe UTIs
- Skin and skin structure infections
- Complicated intra-abdominal infections
- Any infection requiring doses of 2 g 1
Pharmacokinetic Support
The IM route has excellent bioavailability when used appropriately:
- 100% absolute bioavailability after IM administration
- Rapid absorption with peak concentrations at 1.0-1.6 hours
80% excreted unchanged in urine
- Well tolerated with minimal injection site discomfort 2
Clinical Practice Pitfall
Do not use IM cefepime for serious infections or empiric therapy. The restriction to mild-moderate E. coli UTIs only is explicit in the FDA labeling. For nursing home-acquired pneumonia, while one study used 1 g IM daily 3, this is off-label and IV remains the standard route for pneumonia per FDA guidance 1.
Renal Dosing Considerations
Even for the approved IM indication, adjust dosing if creatinine clearance ≤60 mL/min using the same renal adjustment tables as IV administration 1.