From the FDA Drug Label
Mild to Moderate Uncomplicated or Complicated Urinary Tract Infections, including pyelonephritis, due to E. coli, K. pneumoniae, or P. mirabilis† 0. 5 to 1 gIV/IM¶ Every 12 hours 7 to 10 Severe Uncomplicated or Complicated Urinary Tract Infections, including pyelonephritis, due to E. coli or K. pneumoniae† 2 g IV Every 12 hours 10
The recommended dose of Cefipime for a UTI with E. coli ESBL is:
- Mild to Moderate: 0.5 to 1 g IV/IM every 12 hours
- Severe: 2 g IV every 12 hours 1
From the Research
For urinary tract infections (UTIs) caused by ESBL-producing E. coli, cefepime is not typically recommended as first-line therapy due to potential resistance. The preferred treatment is a carbapenem such as meropenem (1g IV every 8 hours), ertapenem (1g IV daily), or imipenem (500mg IV every 6 hours) for 7-14 days depending on infection severity 2. If cefepime must be used based on susceptibility testing, high-dose therapy of 2g IV every 8 hours with extended infusion over 3-4 hours is recommended to optimize pharmacodynamics against ESBL organisms. Treatment duration should be 7 days for uncomplicated UTIs and 10-14 days for complicated infections or pyelonephritis. It's crucial to confirm susceptibility with minimum inhibitory concentration (MIC) testing before using cefepime, as ESBL enzymes can hydrolyze most cephalosporins 3. Even with documented susceptibility, clinical failures with cefepime have been reported against ESBL producers due to the inoculum effect, which is why carbapenems remain the safest empiric choice for these resistant infections. Key points to consider in the treatment of UTIs caused by ESBL-producing E. coli include:
- The use of carbapenems as first-line therapy due to their broad-spectrum activity and stability against ESBL enzymes 2
- The importance of susceptibility testing to guide antibiotic selection, particularly when using cefepime or other non-carbapenem antibiotics 3
- The potential for clinical failures with cefepime despite documented susceptibility, highlighting the need for close monitoring and consideration of alternative therapies 3