Cefepime Dosing for Urinary Tract Infections
For urinary tract infections (UTIs), cefepime should be dosed at 0.5-1 g IV every 12 hours for mild to moderate uncomplicated or complicated UTIs for 7-10 days, and 2 g IV every 12 hours for severe uncomplicated or complicated UTIs for 10 days. 1
Dosing Recommendations Based on UTI Severity
Mild to Moderate UTIs
- Dose: 0.5-1 g IV every 12 hours
- Duration: 7-10 days
- Administration: Intravenous infusion over approximately 30 minutes
Severe UTIs
- Dose: 2 g IV every 12 hours
- Duration: 10 days
- Administration: Intravenous infusion over approximately 30 minutes
Renal Dosing Adjustments
Cefepime dosing must be adjusted in patients with renal impairment:
| Creatinine Clearance | Recommended Dosing |
|---|---|
| >60 mL/min | Standard dosing as above |
| 30-60 mL/min | 0.5-1 g every 24 hours |
| 11-29 mL/min | 0.5-1 g every 24 hours |
| ≤10 mL/min | 0.25-0.5 g every 24 hours |
Clinical Evidence
Cefepime has demonstrated high efficacy in the treatment of UTIs. In clinical trials, cefepime produced satisfactory clinical responses in 89% of patients with complicated UTIs and 92% of patients with uncomplicated UTIs 2. Bacterial eradication rates were 85% for both complicated and uncomplicated UTIs.
The FDA-approved labeling specifically indicates cefepime for both uncomplicated and complicated urinary tract infections, with clear dosing recommendations based on the severity of infection 1.
Special Considerations
- Obtain urine culture before starting antibiotics to allow for targeted therapy if initial empiric treatment fails
- Monitor renal function during therapy, especially in elderly patients who are more susceptible to adverse effects
- Common adverse events include headache, diarrhea, and vomiting
- Local tolerance is generally good with proper administration
Alternative Treatments for UTIs
If cefepime is not appropriate, consider these alternatives based on local resistance patterns:
- Nitrofurantoin: 100 mg twice daily for 5 days (uncomplicated UTIs)
- TMP-SMX: 160/800 mg twice daily for 3 days (if local resistance <20%)
- Fosfomycin: 3g single dose (especially for patients with multiple allergies)
- Fluoroquinolones: Only when other options are not suitable due to resistance concerns
Monitoring
- Assess clinical response within 48-72 hours
- If symptoms worsen or don't improve, reevaluate for possible pyelonephritis or complicated UTI
- Consider imaging studies if structural abnormalities are suspected
- Monitor for neurotoxicity, especially in patients with renal impairment
Cefepime remains an effective option for UTIs, particularly for hospitalized patients or those with more severe infections requiring parenteral therapy.