What is the recommended treatment for pneumonia, including dosage and duration?

From the Guidelines

Cefepime is not the first-line treatment for pneumonia, and its dosage for pneumonia is typically 1-2 grams every 8-12 hours. The recommended treatment for pneumonia depends on whether it's community-acquired (CAP) or hospital-acquired, and the patient's age and health status. For typical CAP in adults, amoxicillin 500mg three times daily for 5-7 days is the first-line treatment, as per the American Thoracic Society and Infectious Diseases Society of America guidelines 1. Alternatives include doxycycline 100mg twice daily or clarithromycin 500mg twice daily for the same duration. Some key points to consider when treating pneumonia include:

• The use of combination therapy, such as amoxicillin-clavulanate 875/125mg twice daily plus azithromycin 500mg once daily for 5-7 days, for more severe cases or those with comorbidities 1.
• The importance of supportive care, including adequate hydration, rest, and fever control with acetaminophen or ibuprofen.
• The need for patients to complete the full antibiotic course even if symptoms improve quickly to prevent recurrence and antibiotic resistance.
• The role of newer antibiotics, such as solithromycin, nemonaxacin, delafoxacin, omadacycline, and lefamulin, which have shown promise in treating CAP, but may not be approved or recommended as first-line treatments yet 1. Some specific considerations for cefepime include:
• Its broad-spectrum activity against Gram-positive and Gram-negative bacteria, including Pseudomonas aeruginosa.
• Its potential use as a second-line treatment for pneumonia, particularly in cases where other antibiotics are not effective or tolerated.
• The importance of monitoring for potential side effects, such as allergic reactions and nephrotoxicity, when using cefepime. In terms of dosage and duration, cefepime is typically administered at a dose of 1-2 grams every 8-12 hours, with a treatment duration of 5-7 days for uncomplicated cases, though some patients may need longer courses 1. It's worth noting that the IDSA/ATS 2019 guideline recommends clinicians to continue antibiotics until the patient achieves stability using a validated measure of clinical stability, and the duration is not less than a total of 5 days 1. Overall, while cefepime may be an effective treatment for pneumonia in certain cases, it is not the first-line treatment, and its use should be guided by clinical judgment and evidence-based guidelines.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Recommended Dosage in Adults With Creatinine Clearance (CrCL) Greater Than 60 mL/min Site and Type of Infection (Adults) Dose (IV) Frequency Duration (Days)

• For Pseudomonas aeruginosa, use 2 g IV every 8 hours Moderate to Severe Pneumonia * 1-2 g Every 8-12 hours 10

The recommended dose of Cefepime for pneumonia is 1-2 g administered every 8-12 hours for a duration of 10 days 2.

From the Research

Cefepime Dosage for Pneumonia

• The recommended dosage of cefepime for pneumonia is 1-2g, administered intravenously twice daily 3.
• Cefepime monotherapy has been shown to be as effective as ceftazidime, ceftriaxone, or cefotaxime monotherapy in treating hospitalized adult or pediatric patients with moderate to severe community-acquired or nosocomial pneumonia 3.
• For patients with nosocomial pneumonia, cefepime 2g three times daily has been shown to be as effective as imipenem/cilostatin 0.5g four times daily 3.

Duration of Treatment

• The duration of treatment with cefepime for pneumonia has not been specifically stated in the provided studies, but it is generally recommended to continue treatment for at least 48 hours after the patient has become afebrile and has shown significant clinical improvement 3.

Special Considerations

• For patients with gram-negative infections, higher dosing regimens of cefepime (2g every 8 hours or 1g every 6 hours) may be necessary to treat serious infections with elevated minimum inhibitory concentrations (MICs) 4.
• Extended infusion of cefepime (1g every 6 hours administered over 3 hours) has been shown to achieve pharmacodynamic efficacy against bacteria with a MIC of ≤8 mg/L, and may be a cost-effective alternative to intermittent infusion 5.

Combination Therapy

• The use of combination therapy with a beta-lactam plus a macrolide or doxycycline, or monotherapy with a "respiratory quinolone", has been suggested as optimal first-line therapy for patients hospitalized with community-acquired pneumonia 6.
• However, a systematic review and meta-analysis found that the available body of evidence had very low quality, and that well-designed randomized controlled trials are needed to compare the effectiveness of different treatment regimens 7.