Cefepime Dosing for Providencia stuartii UTI in 93-Year-Old Female with Normal Renal Function
For a 93-year-old female with Providencia stuartii urinary tract infection and normal renal function, the recommended dose of cefepime is 1-2 g intravenously every 12 hours. 1
Rationale for Dosing Selection
Age Considerations
- Although the patient has normal renal function, her advanced age (93 years) warrants careful consideration when selecting antimicrobial dosing
- For patients over 59 years of age, dose adjustments may be considered even with normal renal function 1
Pathogen-Specific Considerations
- Providencia stuartii is a gram-negative bacterium commonly associated with complicated urinary tract infections
- According to the FDA label, cefepime has documented activity against Providencia stuartii 2
- Cefepime achieves high urinary concentrations, with mean urine concentrations of 926-3120 mcg/mL depending on dose 2
Dosing Guidelines
The European Association of Urology guidelines specifically recommend cefepime at 1-2 g twice daily for complicated urinary tract infections 1:
| Antimicrobial | Daily dose | Comments |
|---|---|---|
| Cefepime | 1-2 g b.i.d. | Lower dose studied, but higher dose recommended |
Monitoring Recommendations
- Monitor renal function regularly during treatment
- Watch for neurological symptoms (confusion, muscle jerks) which may indicate cefepime neurotoxicity, especially in elderly patients 3
- Assess clinical response within 48-72 hours of initiating therapy
Important Considerations and Caveats
Potential for Neurotoxicity
- Despite normal renal function, elderly patients may still be at risk for cefepime-associated neurotoxicity
- Studies have shown that 10% of ICU patients may experience cefepime accumulation despite dosage adjustments 3
- Monitor for symptoms of non-convulsive epilepsy, confusion, or muscle jerks
Antimicrobial Resistance
- Consider local resistance patterns when selecting therapy
- If susceptibility testing shows MIC values ≥8 mg/L, higher dosing or alternative agents may be necessary 3
Duration of Therapy
- For complicated UTIs in elderly patients, a 7-14 day course is typically recommended
- Duration should be based on clinical response and resolution of symptoms
Alternative Options
If cefepime cannot be used or is not appropriate:
- Fluoroquinolones (if susceptible): Ciprofloxacin 400 mg IV twice daily
- Aminoglycosides: Amikacin 15 mg/kg once daily (with monitoring)
- Carbapenems: Consider only if multidrug resistance is documented
Remember that while the patient has normal renal function now, elderly patients are at higher risk for developing acute kidney injury during hospitalization, which would necessitate dose adjustment.