Cefepime Dosing for Urinary Tract Infections
For urinary tract infections, cefepime should be dosed at 0.5-1 g IV every 12 hours for mild to moderate uncomplicated or complicated UTIs, and 2 g IV every 12 hours for severe uncomplicated or complicated UTIs, with treatment duration of 7-10 days. 1
Dosing Recommendations Based on UTI Severity
Uncomplicated UTIs
- Mild to Moderate: 0.5-1 g IV every 12 hours for 7-10 days 1
- Severe: 2 g IV every 12 hours for 10 days 1
Complicated UTIs
- Mild to Moderate: 0.5-1 g IV every 12 hours for 7-10 days 1
- Severe: 2 g IV every 12 hours for 10 days 1
Special Considerations
Renal Dosing Adjustments
Cefepime dosing must be adjusted based on creatinine clearance:
- CrCl >60 mL/min: Standard dosing as above
- CrCl ≤60 mL/min: Dose reduction required 1
Pseudomonas Coverage
- For UTIs where Pseudomonas aeruginosa is suspected or confirmed, use 2 g IV every 8 hours 1
- This higher dosing regimen is essential for adequate coverage of Pseudomonas, which requires higher concentrations of the antibiotic 2
Clinical Evidence and Rationale
The FDA-approved labeling for cefepime clearly outlines the dosing recommendations for UTIs based on severity 1. These recommendations are supported by clinical studies showing high efficacy rates:
- Clinical studies have demonstrated that cefepime produces satisfactory clinical responses in 89% of patients with complicated UTIs and 92% of patients with uncomplicated UTIs 3
- Bacterial eradication rates with cefepime were 85% for both complicated and uncomplicated UTIs 3
The World Society of Emergency Surgery guidelines also recommend cefepime (2 g every 8 hours) plus metronidazole for critically ill patients with intra-abdominal infections, which may include urinary source infections 2.
Administration Guidelines
- Administer intravenously over approximately 30 minutes 1
- Do not force thaw frozen container by immersion in water baths or by microwave irradiation 1
- Monitor for clinical response and adjust therapy based on culture and sensitivity results
Potential Adverse Effects
The most common adverse reactions (incidence ≥1%) with cefepime include:
- Local reactions at injection site
- Positive Coombs' test
- Decreased phosphorous
- Increased ALT and AST
- Increased PT and PTT
- Rash 1
At the highest dose (2 g every 8 hours), additional adverse reactions with ≥1% incidence include diarrhea, nausea, vomiting, pruritus, fever, and headache 1.
Important Warnings
- Monitor for neurotoxicity, especially in patients with renal impairment receiving unadjusted doses 1
- Cross-hypersensitivity among beta-lactam antibiotics may occur in up to 10% of patients with penicillin allergy 1
- Monitor for Clostridioides difficile-associated diarrhea 1
Remember that cefepime is a fourth-generation cephalosporin with excellent activity against many gram-negative pathogens, including Pseudomonas aeruginosa, making it particularly valuable for complicated UTIs where resistant organisms may be present.