What is the dose for Fetroja (Cefiderocol)?

From the FDA Drug Label

1. 1 Recommended Dosage The recommended dosage of FETROJA is 2 grams administered every 8 hours by intravenous (IV) infusion over 3 hours in adults with a creatinine clearance (CLcr) of 60 to 119 mL/min

2. 2 Dosage Adjustments in Patients with CLcr Less Than 60 mL/min (Including Patients Undergoing Intermittent HD or CRRT), and CLcr 120 mL/min or Greater

Table 1 Recommended Dosage of FETROJA for Patients with CLcr Less Than 60 mL/min Including Patients Receiving Intermittent HD

• CLcr 30 to 59 mL/min: 1.5 grams Every 8 hours
• CLcr 15 to 29 mL/min: 1 gram Every 8 hours
• CLcr less than 15 mL/min, with or without intermittent HD: 0.75 grams Every 12 hours

Table 2 Recommended Dosage of FETROJA for Patients Receiving CRRT

• 2 L/hr or less: 1.5 grams every 12 hours
• 2.1 to 3 L/hr: 2 grams every 12 hours
• 3.1 to 4 L/hr: 1.5 grams every 8 hours
• 4.1 L/hr or greater: 2 grams every 8 hours

For patients with CLcr greater than or equal to 120 mL/min, FETROJA 2 grams administered every 6 hours by IV infusion over 3 hours is recommended

The recommended dose of FETROJA is:

• 2 grams every 8 hours for adults with a creatinine clearance (CLcr) of 60 to 119 mL/min
• 1.5 grams every 8 hours for adults with a CLcr of 30 to 59 mL/min
• 1 gram every 8 hours for adults with a CLcr of 15 to 29 mL/min
• 0.75 grams every 12 hours for adults with a CLcr of less than 15 mL/min
• For patients receiving CRRT, the dosage is based on the effluent flow rate
• For patients with CLcr 120 mL/min or greater, the recommended dose is 2 grams every 6 hours 1

From the Research

The recommended dose of Fetroja (cefiderocol) for adults with normal kidney function is 2 grams administered intravenously every 8 hours, as supported by the most recent and highest quality study 2. Each dose should be infused over 3 hours. For patients with impaired kidney function, dose adjustments are necessary:

• for creatinine clearance 30-59 mL/min, reduce to 1.5 grams every 8 hours;
• for 15-29 mL/min, give 1 gram every 8 hours;
• and for less than 15 mL/min, administer 0.75 grams every 8 hours. Hemodialysis patients should receive doses after dialysis sessions. The typical treatment duration ranges from 7 to 14 days depending on the infection type and severity. Fetroja is a siderophore cephalosporin antibiotic that works by binding to iron and using bacterial iron transport systems to enter cells, where it inhibits cell wall synthesis. This unique mechanism allows it to overcome certain resistance mechanisms in gram-negative bacteria, making it effective against multidrug-resistant pathogens including Pseudomonas aeruginosa and carbapenem-resistant Enterobacteriaceae, as demonstrated in studies 3, 4, 5, 6.

Some key points to consider when using Fetroja include:

• Its efficacy against a range of gram-negative bacteria, including those resistant to other antibiotics 2, 3
• The importance of dose adjustment in patients with impaired kidney function to minimize the risk of adverse effects 2
• The potential for Fetroja to be used in combination with other antibiotics to enhance its effectiveness against certain pathogens 4
• The need for careful monitoring of patients receiving Fetroja, particularly those with underlying medical conditions or taking other medications that may interact with the antibiotic 2, 6

Overall, Fetroja is a valuable addition to the arsenal of antibiotics available for the treatment of gram-negative infections, and its use should be guided by the most recent and highest quality evidence available 2.