What is the appropriate dosing for Cefepime (Cefepime), a fourth-generation cephalosporin (4th generation cephalosporin) antibiotic?

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's essential to take into account the patient's renal function, as dosage adjustments are necessary for those with renal impairment.

• For patients with creatinine clearance 30-60 mL/min, the dose should be adjusted to 1-2 grams every 12-24 hours.
• For clearance 11-29 mL/min, the dose should be 0.5-1 gram every 24 hours.
• For clearance less than 10 mL/min, the dose should be 0.25-0.5 grams every 24 hours.

Treatment Duration and Monitoring

Treatment duration with cefepime typically ranges from 7-14 days, depending on the infection site and severity. Patients should be monitored for potential side effects, such as seizures, especially those with renal impairment or neurological conditions.

Spectrum of Activity

Cefepime is a fourth-generation cephalosporin with broad-spectrum activity against gram-positive and gram-negative bacteria, including Pseudomonas aeruginosa, making it a valuable option for empiric therapy in healthcare-associated infections 1.

Clinical Guidelines

The recommended dosing of cefepime is supported by clinical guidelines, which emphasize the importance of appropriate antibiotic therapy in reducing morbidity, mortality, and improving quality of life in patients with serious infections 1.

From the FDA Drug Label

Moderate to Severe Pneumonia due to S. pneumoniae†, P. aeruginosa‡, K pneumoniae, or Enterobacter species 1 to 2 g IV Every 8 to 12 hours Empiric therapy for febrile neutropenic patients (See INDICATIONS AND USAGE and CLINICAL STUDIES.) 2 g IV Every 8 hours 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 Severe Uncomplicated or Complicated Urinary Tract Infections, including pyelonephritis, due to E. coli or K. pneumoniae† 2 g IV Every 12 hours Moderate to Severe Uncomplicated Skin and Skin Structure Infections due to S. aureus or S. pyogenes 2 g IV Every 12 hours Complicated Intra-abdominal Infections (used in combination with metronidazole) caused by E coli, viridans group streptococci, P. aeruginosa‡, K. pneumoniae, Enterobacterspecies, or B. fragilis. (See CLINICAL STUDIES.) 2 g IV Every 8 to 12 hours

The recommended dosing schedule for cefepime is as follows:

• Moderate to Severe Pneumonia: 1 to 2 g IV every 8 to 12 hours
• Empiric therapy for febrile neutropenic patients: 2 g IV every 8 hours
• Mild to Moderate Uncomplicated or Complicated Urinary Tract Infections: 0.5 to 1 g IV/IM every 12 hours
• Severe Uncomplicated or Complicated Urinary Tract Infections: 2 g IV every 12 hours
• Moderate to Severe Uncomplicated Skin and Skin Structure Infections: 2 g IV every 12 hours
• Complicated Intra-abdominal Infections: 2 g IV every 8 to 12 hours In patients with renal impairment, the dose of cefepime should be adjusted according to the creatinine clearance, as presented in Table 11 2.

From the Research

Cefepime Dosing

• Cefepime is a fourth-generation cephalosporin with a broad spectrum of antibacterial activity, effective against many organisms causative of pneumonia 3.
• 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 or pediatric patients with moderate to severe community-acquired or nosocomial pneumonia 3.
• In patients with AmpC beta-lactamase-producing Enterobacterales bloodstream infections, cefepime may be used as a safe treatment strategy, particularly in clinically stable patients without initial renal impairment or increased susceptibility to neurological adverse events 4.
• For the treatment of severe pneumonia and sepsis, cefepime is recommended as a monotherapy or combination therapy option, providing coverage of a broad spectrum of Gram-negative and Gram-positive bacteria, including Pseudomonas aeruginosa 5.
• In patients with moderate-to-severe aspiration pneumonia, cefepime has been shown to be as effective and safe as meropenem, with a clinical response rate similar to that of meropenem 6.
• Cefepime or carbapenem treatment as a single agent has been found to be as effective as a combination of 4th-generation cephalosporin + aminoglycosides for febrile neutropenia 7.

Key Considerations

• Cefepime dosing should be adjusted based on the severity of the infection, the patient's renal function, and the presence of any underlying conditions that may affect the drug's efficacy or safety.
• The choice of cefepime as a treatment option should be guided by local and national resistance data, as well as the patient's individual needs and medical history.
• Cefepime has been shown to be generally well-tolerated, with a tolerability profile similar to that of other parenteral cephalosporins, but adverse events such as rash, diarrhea, and neurological adverse events have been reported 3, 4.