Cefepime Dosage and Treatment Guidelines for Adults with Severe Infections
For adults with severe infections, cefepime should be administered at a dose of 2g IV every 8-12 hours, with duration of 7-10 days depending on the specific infection type and clinical response. 1
Recommended Dosing by Infection Type
Severe Respiratory Infections
- Moderate to severe pneumonia (including Pseudomonas aeruginosa): 1-2g IV every 8-12 hours for 10 days 1
- For pneumonia due to P. aeruginosa specifically: 2g IV every 8 hours 1
- Consider extended infusion (3-4 hours) instead of standard 30-minute infusions for improved pharmacodynamic exposure in serious infections 2
Intra-abdominal Infections
- Complicated intra-abdominal infections: 2g IV every 8-12 hours for 7-10 days (in combination with metronidazole) 1
- For healthcare-associated intra-abdominal infections: cefepime in combination with metronidazole is recommended as one of the first-line options 2
Febrile Neutropenia
- Empiric therapy: 2g IV every 8 hours until resolution of neutropenia or for at least 7 days 1
- Re-evaluate the need for continued antimicrobial therapy frequently if fever resolves but neutropenia persists beyond 7 days 1
Urinary Tract Infections
- Severe uncomplicated or complicated UTIs: 2g IV every 12 hours for 10 days 1
Dosage Adjustments for Renal Impairment
Cefepime requires dose adjustment in patients with renal impairment:
| Creatinine Clearance | Recommended Dose |
|---|---|
| >60 mL/min | Standard dose |
| 30-60 mL/min | Same initial dose, then 50% of normal dose at same interval |
| 11-29 mL/min | Same initial dose, then 25% of normal dose at same interval |
| ≤10 mL/min | Same initial dose, then 12.5% of normal dose at same interval |
Administration Considerations
- Standard administration: Intravenous infusion over approximately 30 minutes 1
- For severe infections, especially with pathogens having high MICs, consider extended infusion of 3-4 hours to optimize pharmacodynamics 2
- Maintain plasma concentrations of β-lactam antibiotics above MIC for at least 70% of the time to increase success rate 2
- For critically ill patients, aim for higher target (Cmin/MIC >4-6) 2
Special Populations and Considerations
Healthcare-Associated Infections
- For healthcare-associated infections, cefepime is recommended as one of the options for empiric coverage of likely pathogens 2
- For suspected MRSA, add vancomycin to the regimen 2
- For suspected P. aeruginosa, cefepime is an appropriate empiric choice 2
Combination Therapy
- For severe infections with suspected P. aeruginosa, two antipseudomonal antibiotics may be used empirically due to the risk of non-susceptibility to a single agent 2
- When culture and susceptibility reports become available, de-escalate therapy to reduce the number and spectra of administered agents 2
Monitoring and Duration
- Evaluate clinical response within 48-72 hours
- Monitor renal function regularly and adjust dosing as needed
- Standard duration for most severe infections is 7-10 days, but may be extended based on clinical response
- For intra-abdominal infections with adequate source control, 4-5 days may be sufficient 2
Potential Pitfalls
- Underdosing in critically ill patients with altered pharmacokinetics
- Failure to adjust doses in renal impairment
- Inadequate duration of therapy for deep-seated infections
- Overlooking source control, which is essential for treatment success
- In settings with high incidence of ESBL-producing Enterobacteriaceae, extended use of cephalosporins should be limited to pathogen-directed therapy due to selection pressure resulting in emergence of resistance 2
Cefepime remains a valuable broad-spectrum antibiotic for severe infections, particularly due to its stability against many beta-lactamases and activity against Pseudomonas aeruginosa. Its pharmacokinetic profile with an elimination half-life of approximately 2 hours makes it suitable for twice or thrice daily dosing in patients with normal renal function 3.