From the Guidelines
The recommended dose of Cefepime for pediatric patients is 50 mg/kg every 12 hours for infants over 14 days of age and children weighing ≤40 kg, with specific considerations for neonates under 14 days of age who should receive 30 mg/kg every 12 hours. When considering the treatment of pediatric patients with Cefepime, it's crucial to take into account the patient's age, weight, and renal function, as these factors significantly influence the appropriate dosage and potential need for adjustments 1. For pediatric patients, especially those with severe infections, the dosage might need to be adjusted based on the severity of the infection and the patient's clinical response. Key considerations include:
- Neonates ≤14 days of age: 30 mg/kg every 12 hours
- Infants >14 days of age and children ≤40 kg: 50 mg/kg every 12 hours
- The lack of specific recommendations for infants between 2 weeks to 2 months of age necessitates careful clinical judgment and potentially consultation with a pediatric infectious disease specialist. Given the potential for renal impairment to affect Cefepime clearance, monitoring and appropriate dose adjustments are critical to avoid toxicity, particularly in patients with pre-existing renal issues 1. It's also important to be aware of the potential side effects, including hypersensitivity reactions, seizures, and the risk of Clostridioides difficile-associated diarrhea, especially in patients with compromised renal function or those receiving prolonged courses of therapy. The administration of Cefepime should be intravenous, preferably over 30 minutes, to minimize the risk of adverse effects. In clinical practice, the treatment duration with Cefepime typically ranges from 7 to 14 days, depending on the type and severity of the infection, as well as the patient's clinical response to therapy. Given the broad-spectrum activity of Cefepime, including its efficacy against Pseudomonas aeruginosa, it is a valuable option for the treatment of serious gram-positive and gram-negative bacterial infections in pediatric patients.
From the FDA Drug Label
The usual recommended dosage in pediatric patients up to 40 kg in weight for uncomplicated and complicated urinary tract infections (including pyelonephritis), uncomplicated skin and skin structure infections, and pneumonia is 50 mg per kg per dose, administered every 12 hours (50 mg per kg per dose, every 8 hours for febrile neutropenic patients), for durations as given above For Pseudomonas aeruginosa, use 2 g IV every 8 hours (50 mg per kg per dose in pediatric patients 2 months up to 16 years)
The recommended dose of Cefepime for pediatric patients is:
- 50 mg per kg per dose, administered every 12 hours for uncomplicated and complicated urinary tract infections, uncomplicated skin and skin structure infections, and pneumonia
- 50 mg per kg per dose, administered every 8 hours for febrile neutropenic patients
- 50 mg per kg per dose, administered every 8 hours for Pseudomonas aeruginosa infections 2
From the Research
Cefepime Pediatric Dose
The recommended dose of Cefepime for pediatric patients is as follows:
- For patients ≥ 2 months of age, a dose of 50 mg/kg every 12 hours is recommended to treat infections caused by pathogens for which cefepime MICs are ≤ 8 mg/liter 3
- However, for neonates, the dosage regimen may need to be adjusted based on the minimum inhibitory concentration (MIC) of the pathogen and the postmenstrual age of the patient 4
- A study suggests that for 70% of neonates to obtain a higher free drug concentration than the MIC during 70% of the dosing interval, 50 mg/kg q12 h is needed with a susceptibility breakpoint of 4 mg/l, while for a MIC of 8 mg/l, 40 mg/kg q8 h is recommended for all neonates 4
Special Considerations
- In critically ill pediatric patients on continuous renal replacement therapy (CRRT), therapeutic drug monitoring of cefepime should be considered to minimize the risk of side effects and ensure effective treatment 5
- The pharmacokinetic characteristics of cefepime in infants and children have been studied, and the results support a single cefepime dosing strategy for patients ≥ 2 months of age 3