What is the recommended dose of Cefepime (Cefepime) for pneumonia (PNA) in patients with normal kidney function?

Cefepime Dosing for Pneumonia with Normal Kidney Function

For patients with pneumonia and normal kidney function, the recommended dose of cefepime is 1-2 g IV every 8-12 hours for 7-10 days. 1, 2

Specific Dosing Recommendations by Pneumonia Type

Community-Acquired Pneumonia (CAP)

• Moderate to Severe CAP: 1-2 g IV every 8-12 hours for 10 days 1
• For Pseudomonas aeruginosa coverage: 2 g IV every 8 hours 1, 2

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

• Low risk of multidrug-resistant organisms (MDROs): 2 g IV every 8 hours 2
• High risk of MDROs: 2 g IV every 8 hours 2
• For confirmed Pseudomonas aeruginosa infection:
  • Stable hemodynamics: 2 g IV every 8 hours
  • Unstable hemodynamics: 2 g IV every 8 hours (consider combination therapy) 2

Administration Considerations

• Administer intravenously over approximately 30 minutes 1
• For severe infections, especially in critically ill patients, consider extended infusion (3-4 hours) to optimize pharmacokinetic/pharmacodynamic parameters 3

Special Situations

ICU Patients

• For ICU patients with severe pneumonia: 2 g IV every 8 hours 2
• For patients on ECMO: Consider a 3 g loading dose followed by 2 g every 8 hours 4

Combination Therapy Considerations

• For severe CAP or HAP/VAP with suspected Pseudomonas infection, consider combination therapy with an aminoglycoside or fluoroquinolone 2
• For prosthetic valve endocarditis with pneumonia: 6 g per day IV in 3 divided doses (2 g every 8 hours) 2

Duration of Therapy

• Standard duration: 7-10 days 2, 1
• For CAP: Minimum of 5 days, should be afebrile for 48-72 hours, and have no more than 1 CAP-associated sign of clinical instability before discontinuation 2
• For HAP/VAP: 10-14 days for bloodstream infection or pneumonia 2

Switch to Oral Therapy

• Consider switching to oral therapy when the patient is hemodynamically stable, improving clinically, able to ingest medications, and has a normally functioning gastrointestinal tract 2

Common Pitfalls and Caveats

1. Dosing errors: Using standard doses in critically ill patients may lead to subtherapeutic concentrations due to altered pharmacokinetics 3
2. Inadequate loading dose: Particularly important in ECMO patients who have significantly increased volume of distribution (2.8-fold) 4
3. Failure to adjust for renal function changes: While the question specifies normal renal function, it's crucial to monitor renal function throughout therapy as it may change, requiring dose adjustments 1
4. Inadequate duration: Stopping therapy too early can lead to treatment failure; ensure the patient meets clinical stability criteria before discontinuation 2
5. Inappropriate monotherapy: For suspected or confirmed Pseudomonas infections in critically ill patients, combination therapy may be warranted initially 2

Cefepime remains an excellent choice for pneumonia due to its broad spectrum of activity against both gram-positive and gram-negative pathogens, including Pseudomonas aeruginosa, while maintaining activity against many beta-lactamase-producing organisms 5.