Cefepime Dosing in Adults with Normal and Impaired Renal Function
The recommended dosing for cefepime in adults with normal renal function is 1-2g IV every 8-12 hours, with dose adjustments required for patients with renal impairment based on creatinine clearance. 1
Normal Renal Function (CrCl >60 mL/min)
Cefepime dosing varies based on the type and severity of infection:
- Moderate to severe pneumonia: 1-2g IV every 8-12 hours for 10 days 1
- Febrile neutropenia: 2g IV every 8 hours for 7 days or until resolution of neutropenia 1
- Mild to moderate UTIs: 0.5-1g IV every 12 hours for 7-10 days 1
- Severe UTIs: 2g IV every 12 hours for 10 days 1
- Skin and skin structure infections: 2g IV every 12 hours for 10 days 1
- Complicated intra-abdominal infections (with metronidazole): 2g IV every 8-12 hours for 7-10 days 1
- Infective endocarditis: 2g IV every 8-12 hours 2
Renal Impairment Dosing Adjustments
Dosage adjustments are essential in patients with renal impairment to prevent drug accumulation and potential neurotoxicity 3, 4:
| Creatinine Clearance (mL/min) | 500mg dose | 1g dose | 2g dose | 2g (q8h) dose |
|---|---|---|---|---|
| >60 | q12h | q12h | q12h | q8h |
| 30-60 | q24h | q24h | q24h | q12h |
| 11-29 | q24h | q24h | q24h | q24h |
| <11 | q24h | q24h | q24h | q24h |
Special Populations
Hemodialysis patients:
- Initial dose: 1g on day 1
- Maintenance: 500mg every 24 hours (for most infections)
- For febrile neutropenia: 1g every 24 hours
- Administer after completion of hemodialysis on dialysis days 1
CAPD patients:
- 500mg every 48 hours for standard doses
- 1g every 48 hours for 1g doses
- 2g every 48 hours for 2g doses 1
Monitoring Recommendations
- Renal function: Monitor creatinine clearance regularly, especially in critically ill patients 3
- Neurological symptoms: Watch for confusion, altered mental status, and muscle jerks, which may indicate cefepime-associated neurotoxicity, particularly in patients with severe renal impairment 3, 4
- Therapeutic efficacy: Ensure appropriate dosing based on the suspected or confirmed pathogen's MIC 3
Important Clinical Considerations
- Cefepime demonstrates linear pharmacokinetics with an elimination half-life of approximately 2-2.5 hours in patients with normal renal function 5
- Approximately 80% of cefepime is excreted unchanged in the urine in patients with normal renal function 5
- Cefepime is removed by hemodialysis (40-68% over 3 hours) and peritoneal dialysis (26% over 72 hours) 5
- Plasma levels can vary significantly between individuals, with up to 40-fold differences in trough concentrations 3
- Patients with severe renal dysfunction (CrCl <30 mL/min) receiving higher doses of cefepime may be at greater risk for neurotoxicity 4
Common Pitfalls to Avoid
Failure to adjust doses in renal impairment: Even with dose adjustments, 10% of patients with renal impairment may still experience cefepime accumulation 3
Missing signs of neurotoxicity: Confusion and muscle jerks may be misattributed to other causes in critically ill patients rather than recognized as cefepime toxicity 3, 4
Inadequate dosing for resistant organisms: Standard dosing may be insufficient for pathogens with MICs ≥8 mg/L 3
Overlooking drug administration timing in dialysis patients: Administer after hemodialysis to prevent premature removal of the drug 1
By following these evidence-based dosing recommendations and monitoring parameters, clinicians can optimize cefepime therapy while minimizing the risk of adverse effects in patients with both normal and impaired renal function.