What is the recommended dose of cefepime for soft tissue infections?

Recommended Cefepime Dosing for Soft Tissue Infections

For soft tissue infections, cefepime should be administered at a dose of 2 g intravenously every 12 hours for 10 days. 1

Evidence-Based Dosing Recommendations

The FDA-approved dosing for cefepime in moderate to severe uncomplicated skin and skin structure infections is 2 g intravenously every 12 hours for 10 days 1. This recommendation is supported by the Infectious Diseases Society of America (IDSA) guidelines, which recommend cefepime as part of the empiric antibacterial therapy regimen for skin and soft tissue infections (SSTIs) in patients with fever and neutropenia 2.

Patient-Specific Considerations

Age-Based Dosing

• Adults with normal renal function: 2 g IV every 12 hours for 10 days 1
• Pediatric patients (2 months to 16 years): 50 mg/kg IV every 12 hours (not to exceed 2 g per dose) 1

Renal Function Adjustments

For patients with impaired renal function, dose adjustment is necessary:

• CrCl >60 mL/min: Standard dose (2 g every 12 hours)
• CrCl ≤60 mL/min: Dose reduction required 1

Special Clinical Scenarios

Neutropenic Patients

For patients with febrile neutropenia and SSTIs, a higher dosing regimen is recommended:

• 2 g IV every 8 hours 1
• Often combined with vancomycin for empiric coverage 2

Severe Infections

For severe soft tissue infections, particularly those involving Pseudomonas aeruginosa:

• Consider increasing frequency to 2 g IV every 8 hours 1

Duration of Therapy

The standard duration for soft tissue infections is 10 days 1. However, the IDSA guidelines suggest that treatment duration for most bacterial SSTIs should be 7-14 days, depending on clinical response 2.

Administration Considerations

• Administer intravenously over approximately 30 minutes 1
• Do not force thaw frozen container by immersion in water baths or by microwave irradiation 1

Monitoring and Follow-Up

• Assess clinical response after 48-72 hours of therapy
• Monitor renal function during treatment, especially in patients with pre-existing renal impairment
• For persistent or recurrent fever in neutropenic patients, consider adding antifungal therapy 2

Common Pitfalls to Avoid

1. Failing to adjust dosing for renal impairment
2. Inadequate duration of therapy for deep-seated infections
3. Not considering surgical intervention for drainage of soft tissue abscesses, especially after marrow recovery in neutropenic patients 2
4. Overlooking the need for combination therapy in polymicrobial infections

Cefepime has demonstrated efficacy in treating serious bacterial infections, including those involving skin and soft tissues, with good clinical outcomes at the recommended dosing regimen 3.