What is the dose of Cefepime for Pseudomonas aeruginosa pneumonia?

Cefepime Dosing for Pseudomonas aeruginosa Pneumonia

For Pseudomonas aeruginosa pneumonia, the recommended dose of cefepime is 2 g intravenously every 8 hours. 1, 2

Dosing Considerations

Standard Dosing

• Dose: 2 g IV every 8 hours
• Duration: 7-10 days 2
• Administration: Infuse over approximately 30 minutes 1

Renal Adjustment

Dosing should be adjusted based on creatinine clearance (CrCl):

• CrCl >60 mL/min: 2 g every 8 hours
• CrCl 30-60 mL/min: 2 g every 12 hours
• CrCl 11-29 mL/min: 2 g every 24 hours
• CrCl <11 mL/min: 1 g every 24 hours 1

Pharmacokinetic/Pharmacodynamic Considerations

The optimal antimicrobial effect against Pseudomonas aeruginosa requires:

• Free drug concentration above MIC (fT>MIC) of >60% of the dosing interval 3
• Standard 2 g every 8-hour dosing achieves this target for organisms with MICs up to 8 μg/mL 3
• Extended infusion (over 3-4 hours) may be beneficial for isolates with higher MICs 4, 5

Clinical Scenarios

Hospital-Acquired Pneumonia (HAP)/Ventilator-Associated Pneumonia (VAP)

• For patients at high risk of mortality or with prior antibiotic exposure, use cefepime 2 g IV every 8 hours as part of combination therapy 2
• Consider adding an aminoglycoside or fluoroquinolone for synergy in severe infections 2

Community-Acquired Pneumonia with Pseudomonas Risk

• For patients with risk factors for Pseudomonas (e.g., structural lung disease, recent hospitalization, frequent antibiotic use), use cefepime 2 g IV every 8 hours 2

Monitoring and Safety

• Monitor renal function regularly, as cefepime accumulation in renal impairment can lead to neurotoxicity 6
• Watch for signs of neurotoxicity (confusion, hallucinations, myoclonus) especially in patients with renal impairment 6
• Consider therapeutic drug monitoring in critically ill patients with variable pharmacokinetics 5

Treatment Response Assessment

• Evaluate clinical response after 48-72 hours
• If no improvement, consider:
  1. Resistant organism (check culture results)
  2. Inadequate drug exposure
  3. Need for source control
  4. Alternative diagnoses 2

Common Pitfalls to Avoid

1. Underdosing: Using 1 g every 12 hours is inadequate for Pseudomonas pneumonia
2. Failure to adjust for renal function: Can lead to toxicity in renal impairment
3. Monotherapy in severe infections: Consider combination therapy for severe infections
4. Inadequate duration: Treat for at least 7 days for Pseudomonas pneumonia
5. Failure to reassess: Cultures and clinical response should guide continued therapy

The 2 g every 8-hour dosing is supported by multiple guidelines and is essential for achieving adequate pharmacodynamic targets against Pseudomonas aeruginosa in pneumonia.