From the Guidelines
Cefepime should be dosed at 2 grams every 8-12 hours for most serious infections in adults with normal renal function, as recommended by the most recent guidelines 1.
Cefepime Dosing Considerations
When considering cefepime dosing, it is essential to take into account the severity of the infection, the patient's renal function, and the potential for drug interactions.
- For patients with normal renal function, the recommended dose is 2 grams every 8-12 hours 1.
- For patients with renal impairment, dosage adjustments are necessary:
- For creatinine clearance 30-60 mL/min, give 1-2 grams every 12-24 hours.
- For clearance 11-29 mL/min, give 0.5-1 gram every 24 hours.
- For clearance less than 10 mL/min, give 0.25-0.5 grams every 24 hours.
Treatment Duration and Monitoring
Treatment duration typically ranges from 7-14 days depending on the infection site and severity.
- Cefepime is a fourth-generation cephalosporin with broad-spectrum activity against gram-positive and gram-negative bacteria, including Pseudomonas aeruginosa 1.
- It works by binding to penicillin-binding proteins, inhibiting bacterial cell wall synthesis.
- Monitor patients for potential side effects including hypersensitivity reactions, seizures (particularly in those with renal impairment), and Clostridioides difficile-associated diarrhea 1.
- Regular assessment of renal function during therapy is important to ensure appropriate dosing.
Clinical Considerations
Delays in the administration of appropriate antibiotic treatment have been associated with greater mortality for patients with severe sepsis, and with greater hospital costs and lengths of stay for patients with ventilator-associated pneumonia 1.
- Therefore, selection of initial appropriate therapy is an important aspect of care for hospitalized patients with serious infections.
- When patients at risk for infection with multidrug-resistant (MDR) pathogens are identified, empiric therapy should be with agents that are known to be effective against these organisms 1.
From the Research
Cefepime Dosing
- Cefepime is a fourth-generation cephalosporin with a broad spectrum of antibacterial activity, effective against Gram-positive and Gram-negative organisms, including Pseudomonas aeruginosa 2.
- The recommended dosing for cefepime is 1 or 2g, usually administered intravenously twice daily, which has been shown to be as effective as ceftazidime, ceftriaxone, or cefotaxime monotherapy in hospitalized adult patients with moderate to severe community-acquired or nosocomial pneumonia 2.
- In clinical trials, cefepime 2g three times daily was also as effective as imipenem/cilostatin 0.5g four times daily in treating patients with nosocomial pneumonia 2.
- A study comparing cefepime and ceftazidime as initial therapy for serious bacterial infections and sepsis syndrome found that cefepime 2.0 g given intravenously every 12 h was as effective and safe as ceftazidime 2.0 g given intravenously every 8 h 3.
- Another study evaluating cefepime versus ceftazidime for treatment of pneumonia found that the clinical outcomes for hospitalized patients treated for serious pneumonia were similar between the two groups, but post-therapy hospitalization and vancomycin co-administration were significantly lower in the cefepime group 4.
Key Findings
- Cefepime has a broader spectrum of activity and reduced potential for development of bacterial resistance compared to ceftazidime 5.
- Cefepime may become a preferred antibacterial agent for infections caused by Enterobacter spp. 2.
- The cure rates for cefepime were 95% for community-acquired pneumonia and 76% for hospital-acquired pneumonia, compared to 60% for ceftazidime in hospital-acquired pneumonia 6.
Comparison with Ceftazidime
- Cefepime and ceftazidime have similar efficacy and safety profiles, but cefepime has the advantage of being administered twice daily, which may lead to a decrease in hospital costs 3.
- Cefepime may have advantages over ceftazidime due to its broader spectrum of activity and reduced potential for development of bacterial resistance 5.