What is the correct dosing of cefepime for hospital-acquired pneumonia in an adult male with normal renal function?

From the Guidelines

For hospital-acquired pneumonia in an adult male with normal renal function, the recommended dosing of cefepime is 2 grams administered intravenously every 8 hours. This recommendation is based on the most recent and highest quality study available, which suggests that cefepime at a dose of 2 grams every 8 hours is an appropriate choice for empiric therapy in patients with hospital-acquired pneumonia, including those at risk for multidrug-resistant pathogens 1. The dosing regimen of cefepime should be adjusted based on renal function, but for patients with normal renal function, the standard dose is sufficient. Cefepime is effective against a broad range of gram-negative bacteria, including Pseudomonas aeruginosa, which is a common cause of hospital-acquired pneumonia.

The total duration of therapy should be guided by clinical response, with most patients requiring at least 7 days of treatment. For patients with severe pneumonia or those infected with difficult-to-treat pathogens, the full 14-day course is often necessary. It is essential to monitor renal function during treatment, as dosage adjustments would be necessary if kidney function deteriorates. Additionally, cultures should be obtained before initiating therapy, and treatment should be narrowed based on culture results when available.

Some key points to consider when using cefepime for hospital-acquired pneumonia include:

• Cefepime should be infused over 30 minutes to minimize the risk of adverse reactions.
• The choice of antibiotic therapy should be guided by local epidemiology and susceptibility patterns.
• Combination therapy may be necessary for patients at risk for multidrug-resistant pathogens.
• De-escalation of therapy should be considered when culture results are available to minimize the risk of antibiotic resistance and adverse reactions.

Overall, cefepime is a valuable option for the treatment of hospital-acquired pneumonia, and its use should be guided by the most recent and highest quality evidence available 1.

From the FDA Drug Label

Table 10: Recommended Dosage Schedule for Cefepime for Injection in Patients with CrCL Greater Than 60 mL/min 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 10

The correct dosing of cefepime for hospital-acquired pneumonia in an adult male with normal renal function is 1 to 2 g IV every 8 to 12 hours for a duration of 10 days 2.

From the Research

Dosing of Cefepime for Hospital-Acquired Pneumonia

The correct dosing of cefepime for hospital-acquired pneumonia in an adult male with normal renal function is as follows:

• Cefepime can be administered at a dose of 2g every 12 hours for patients with creatinine clearance (CLCr) ≥ 50 ml/min 3
• Alternatively, cefepime can be administered at a dose of 1g every 12 hours, as shown in studies comparing its efficacy and safety to ceftazidime in the treatment of hospitalized patients with moderate-to-severe bacterial pneumonia 4
• A 3g loading dose may be necessary to achieve target attainment in patients with ECMO, but this is not directly relevant to patients with normal renal function 5

Important Considerations

• The dosing regimen may need to be adjusted based on renal function, with reduced doses recommended for patients with CLCr < 50 ml/min 3
• Cefepime has been shown to be effective against a broad range of pathogens, including Pseudomonas aeruginosa and other Gram-negative bacteria 6
• The choice of dosing regimen should be based on the specific clinical context and the suspected or confirmed pathogens involved in the infection 6, 5, 4