Recommended Cefepime Dosage for Cellulitis in Patients with Normal Renal Function
For adult patients with cellulitis and normal renal function, the recommended dose of cefepime is 1-2 g intravenously every 12 hours for 5-10 days. 1
Dosing Considerations
The appropriate dosage of cefepime for cellulitis depends on several factors:
Severity of Infection
- Mild to moderate cellulitis: 1 g IV every 12 hours
- Severe or complicated cellulitis: 2 g IV every 12 hours
Administration
- Administer intravenously over approximately 30 minutes
- Duration of therapy is typically 5-10 days, but should be extended if the infection has not improved within this time period 2
Special Considerations
Suspected Pathogens
- For cellulitis likely caused by common skin pathogens (streptococci, MSSA), 1 g every 12 hours is generally sufficient
- For cellulitis with suspected Pseudomonas aeruginosa involvement (such as in immunocompromised patients), consider 2 g every 8-12 hours 1
Risk Factors for Treatment Failure
- For patients with severe systemic symptoms, consider higher doses (2 g every 8-12 hours)
- For patients with risk factors for MRSA, vancomycin or another MRSA-active agent should be considered instead of or in addition to cefepime 2
Monitoring and Safety
- Monitor renal function during therapy, as cefepime requires dose adjustment for impaired renal function
- Be alert for signs of neurotoxicity, which can occur even with normal renal function 3
- Neurotoxicity risk increases with higher plasma concentrations, particularly with trough levels exceeding 8 times the MIC 2
Alternative Regimens
If cefepime is not appropriate, consider these alternatives for cellulitis:
- Beta-lactams: Cefazolin 1-2 g IV every 8 hours 4
- For MRSA coverage: Vancomycin 15-20 mg/kg IV every 8-12 hours 2
- For outpatient treatment: Oral options include clindamycin, TMP-SMX, or doxycycline 2
Common Pitfalls to Avoid
- Failure to adjust dose for renal function: Cefepime accumulation in renal impairment can lead to neurotoxicity
- Inadequate duration: Ensure treatment continues until clinical improvement is evident
- Inappropriate pathogen coverage: Consider local resistance patterns and risk factors for resistant organisms
- Neglecting supportive measures: Remember to elevate the affected area and address predisposing factors such as edema or underlying skin conditions 2
Remember that hospitalization is recommended if there is concern for deeper or necrotizing infection, poor adherence to therapy, severe immunocompromise, or if outpatient treatment is failing 2.