What is the recommended dose and flow rate of Cefepime (Cefipime) for an adult with sepsis?

From the Guidelines

For adults with sepsis, the recommended dose of cefepime is 2 grams administered intravenously every 8 hours, with a standard infusion time of 30 minutes, and a typical flow rate of 2 grams diluted in 100 mL of compatible solution administered over 30 minutes 1.

Key Considerations

• The dose and infusion time may need to be adjusted based on the patient's renal function and the severity of their sepsis.
• For critically ill patients with severe sepsis or septic shock, a higher dose of 2 grams every 6 hours may be considered, particularly for patients with normal renal function 1.
• Cefepime is a fourth-generation cephalosporin with broad-spectrum activity against many gram-positive and gram-negative bacteria, including Pseudomonas aeruginosa, making it appropriate for empiric therapy in sepsis.
• The drug achieves good tissue penetration and has a time-dependent killing mechanism, meaning that maintaining blood levels above the minimum inhibitory concentration is crucial for efficacy, which is why multiple daily doses are recommended.

Administration Modalities

• Administering beta-lactam antibiotics, such as cefepime, by prolonged or continuous infusions may be beneficial for infections due to bacteria with high minimum inhibitory concentrations (MIC) 1.
• Higher daily doses of beta-lactam antibiotics may be necessary to achieve target concentrations in critically ill patients, especially those with preserved renal function 1.

Monitoring and Adjustment

• Therapeutic drug monitoring (TDM) may be necessary to ensure that the patient is receiving an effective dose of cefepime, particularly in patients with renal impairment or those who are critically ill 1.
• The dose of cefepime should be adjusted based on the patient's renal function, with patients having a creatinine clearance of 30-50 mL/min receiving 2 grams every 12 hours.

From the FDA Drug Label

In patients with creatinine clearance less than or equal to 60 mL/min, the dose of cefepime for injection should be adjusted to compensate for the slower rate of renal elimination The recommended initial dose of cefepime for injection should be the same as in patients with normal renal function except in patients undergoing hemodialysis. THE RESULTING SOLUTION SHOULD BE ADMINISTERED OVER APPROXIMATELY 30 MINUTES.

The recommended dose of Cefepime for an adult with sepsis is 2 g IV every 8 hours.

• The flow rate for administration is approximately 30 minutes for the resulting solution. 2

From the Research

Cefepime Dosing for Adult Sepsis

• The recommended dose of Cefepime for adult sepsis is 2 g every 12 hours for patients with creatinine clearance (CLCr) ≥ 50 ml/min 3.
• For patients with CLCr < 50 ml/min, the dose should be adjusted to 2 g every 24 hours or 36 hours 3.
• Another study suggests that Cefepime can be administered as an extended infusion of 1 g every 6 hours over 3 hours, which achieves pharmacodynamic efficacy against bacteria with a MIC of ≤8 mg/L 4.
• The dose of Cefepime can also be given as 2 g every 8 hours as an intermittent infusion 4.

Flow Rate of Cefepime Administration

• Cefepime can be administered as an infusion over 30-60 minutes 5.
• Extended infusion of Cefepime can be given over 3 hours 4.
• Continuous administration of Cefepime is also possible 5.

Special Considerations

• Patients with renal impairment (CLCr < 30 ml/min) may require closer monitoring of Cefepime plasma levels to avoid accumulation and potential neurotoxicity 3.
• Therapeutic drug monitoring of Cefepime may be beneficial in certain patients, including those who are critically ill, have life-threatening infections, or are infected with more resistant pathogens 5.