From the Guidelines
For adult patients with pneumonia, the recommended dose of Cefepime is 4 to 6 g/d, as suggested by experts in the treatment of hospital-acquired pneumonia in the ICU 1.
Dosing Regimen
The dosing regimen of Cefepime varies depending on the presence of risk factors for non-fermenting Gram-negative bacilli, such as antibiotic therapy in the previous 90 days, prior hospital stay of more than 5 days, renal replacement therapy requirement during pneumonia, septic shock, or acute respiratory distress syndrome.
- For late pneumonia (> 5 days) or presence of other risk factors for non-fermenting Gram-negative bacilli, the recommended dose is 4 to 6 g/d 1.
- It is essential to note that the dose may need to be adjusted based on renal function, although the exact adjustments are not specified in the provided evidence.
Rationale
Cefepime is a fourth-generation cephalosporin with broad-spectrum activity against both gram-positive and gram-negative bacteria, including Pseudomonas aeruginosa, making it particularly useful for hospital-acquired pneumonia or when resistant organisms are suspected 1.
Important Considerations
- The use of aminoglycosides, such as amikacin, is favored over fluoroquinolones to limit the emergence of MDR bacteria 1.
- In cases of allergy to beta-lactam antibiotics, alternative treatments such as aztreonam or clindamycin may be considered 1.
- Monitoring of renal function is crucial during Cefepime therapy, especially in elderly patients or those with pre-existing kidney disease.
From the FDA Drug Label
Moderate to Severe Pneumonia due to S. pneumoniae†, P. aeruginosa‡, K pneumoniae, or Enterobacter species 1 to 2 g IV Every 8 to 12 hours Pediatric Patients (2 months up to 16 years) The maximum dose for pediatric patients should not exceed the recommended adult dose. The usual recommended dosage in pediatric patients up to 40 kg in weight for uncomplicated and complicated urinary tract infections (including pyelonephritis), uncomplicated skin and skin structure infections, and pneumonia is 50 mg per kg per dose, administered every 12 hours
The recommended dose and frequency of Cefepime for pneumonia is:
- 1 to 2 g IV every 8 to 12 hours for moderate to severe pneumonia in adults 2
- 50 mg per kg per dose, administered every 12 hours for pediatric patients up to 40 kg in weight 2
From the Research
Recommended Dose and Frequency of Cefepime for Pneumonia
- The recommended dose and frequency of Cefepime for pneumonia vary depending on the severity of the infection and the patient's renal function 3, 4, 5, 6, 7.
- For hospitalized adult patients with moderate to severe community-acquired or nosocomial pneumonia, Cefepime 1 or 2g administered intravenously twice daily has been shown to be effective 3.
- In patients with normal renal function, a dosage regimen of 2g administered through intravenous infusion every 12 hours has been suggested as optimal for a treatment target of 50%fT>MIC 5.
- For patients with renal dysfunction, a dosage regimen of 0.75g administered through continuous infusion over 24 hours may be sufficient for a treatment target of 100%fT>MIC 5.
- Cefepime 2g administered every 12 hours has been compared to Ceftriaxone 1g administered every 12 hours for the empiric treatment of hospitalized patients with community-acquired pneumonia, with comparable safety and efficacy results 6.
- The pharmacokinetic-pharmacodynamic profile of various Cefepime dosing regimens has been assessed, with results suggesting that Cefepime should be successful in achieving the bactericidal target for E. coli and K. pneumoniae, but may require higher doses for P. aeruginosa and A. baumannii 7.
Key Considerations
- Renal function should be considered when deciding the dosing regimen of Cefepime in critically ill patients with hospital-acquired or ventilator-associated pneumonia 5.
- Therapeutic drug monitoring (TDM) to adjust Cefepime trough levels may be useful to improve clinical outcomes and reduce Cefepime neurotoxicity 5.
- The choice of Cefepime dosing regimen should be based on the severity of the infection, the patient's renal function, and the potential for neurotoxicity 3, 4, 5, 6, 7.