What is the recommended dosage and treatment guidelines for Cefepime (Cefepime) in adults with severe infections?

Cefepime Dosage and Treatment Guidelines for Adults with Severe Infections

For adults with severe infections, cefepime should be administered at a dose of 2 grams intravenously every 8-12 hours for 7-14 days, depending on the infection site and severity. 1

Dosage Recommendations by Infection Type

Severe Respiratory Infections

• Moderate to Severe Pneumonia: 1-2 g IV every 8-12 hours for 10 days 1
• Pneumonia due to Pseudomonas aeruginosa: 2 g IV every 8 hours 1
• Healthcare-associated pneumonia: Cefepime 2 g IV every 8-12 hours in combination with metronidazole 2

Intra-abdominal Infections

• Complicated intra-abdominal infections: 2 g IV every 8-12 hours for 7-10 days (used in combination with metronidazole) 1
• Healthcare-associated biliary infections: Cefepime in combination with metronidazole, with vancomycin added to the regimen 2
• Community-acquired severe cholecystitis: Cefepime in combination with metronidazole 2

Febrile Neutropenia

• Empiric therapy: 2 g IV every 8 hours until resolution of neutropenia or for at least 7 days 1

Urinary Tract Infections

• Severe uncomplicated or complicated UTIs: 2 g IV every 12 hours for 10 days 1

Skin and Skin Structure Infections

• Moderate to severe infections: 2 g IV every 12 hours for 10 days 1

Administration Guidelines

• Administer intravenously over approximately 30 minutes 1
• For critically ill patients with severe infections, consider extended or continuous infusion (3-4 hours) to maintain plasma concentrations above MIC for at least 70% of the time 2
• For patients with renal impairment, dosage adjustment is required based on creatinine clearance 1

Special Considerations

Renal Dosage Adjustments

For patients with creatinine clearance ≤60 mL/min, dosage adjustment is necessary:

• CrCl 30-60 mL/min: Reduce dose by 50% (maintain same interval)
• CrCl <30 mL/min: Reduce dose by 75% (maintain same interval)
• Hemodialysis patients: 1 g on dialysis days (administer after dialysis)

Pharmacodynamic Considerations

• For optimal efficacy against severe infections, maintain drug concentrations above the MIC for at least 70% of the dosing interval 2
• For infections with high MIC pathogens, extended infusion (3-4 hours) is recommended 2

Combination Therapy

• For healthcare-associated infections or suspected multidrug-resistant pathogens, cefepime should be used in combination with other agents:
  • Intra-abdominal infections: Combine with metronidazole 2
  • Suspected MRSA: Add vancomycin 2
  • Suspected resistant Pseudomonas: Consider combination with aminoglycoside 2

Monitoring and Duration

• Monitor renal function during therapy
• Assess clinical response after 48-72 hours
• Duration of therapy should be 7-14 days depending on infection site and severity:
  • Pneumonia: 10 days 1
  • Complicated intra-abdominal infections: 7-10 days 1
  • Severe UTIs: 10 days 1
  • Bacteremia: 10-14 days 2

Common Pitfalls and Caveats

• Cefepime may be less effective against ESBL-producing Enterobacteriaceae with high MICs, even if reported as susceptible 2
• For infections with suspected ESBL producers, carbapenems may be preferred over cefepime 2
• Avoid using cefepime monotherapy for empiric treatment of healthcare-associated infections in settings with high prevalence of ESBL-producing organisms 2
• Cefepime should not be used as monotherapy for mixed aerobic/anaerobic infections (e.g., intra-abdominal infections) without adding metronidazole 2

Cefepime is a valuable broad-spectrum antibiotic for severe infections, but appropriate dosing, administration techniques, and combination therapy considerations are essential for optimal outcomes in terms of mortality and morbidity reduction.