Cefepime-Tazobactam Injection: Recommended Use and Dosage
Cefepime-tazobactam is recommended for complicated infections caused by gram-negative pathogens, particularly for multidrug-resistant organisms, with a standard adult dosage of 2g cefepime/2g tazobactam administered intravenously every 8 hours over a 90-minute infusion. 1
Indications for Use
Cefepime-tazobactam is indicated for the treatment of:
- Complicated urinary tract infections (cUTIs) including pyelonephritis 2, 3
- Complicated intra-abdominal infections (in combination with metronidazole) 4
- Healthcare-associated infections with risk of resistant organisms 5
- Infections caused by ESBL-producing Enterobacterales resistant to other antibiotics 1, 6
- Pseudomonas aeruginosa infections, including carbapenem-resistant strains 2
Dosage Recommendations
Standard Adult Dosing
- Standard dose: 2g cefepime/2g tazobactam IV every 8 hours 1, 6
- Infusion time: 90 minutes (prolonged infusion) 1
- Duration: 7-10 days for most infections 2, 4
Renal Dosage Adjustments
Based on creatinine clearance (CrCl) 4, 6:
- CrCl 30-59 mL/min: 1g every 8 hours
- CrCl 15-29 mL/min: 500mg every 8 hours
- CrCl 8-14 mL/min: 500mg every 12 hours
- Hemodialysis patients: 500mg every 12 hours, with additional dose after dialysis
Special Populations
- Augmented renal clearance (CrCl 120-180 mL/min): Standard dose with prolonged 4-hour infusion 6
- Critically ill patients: May require higher end of dosing range with prolonged infusion to ensure adequate drug concentrations 2
Clinical Efficacy
Cefepime-tazobactam has demonstrated:
- Superior efficacy compared to piperacillin-tazobactam in complicated UTIs, with 79.1% vs 58.9% overall treatment success in a phase 3 clinical trial 3
- Activity against 97.6% of Enterobacterales isolates at ≤8 mg/L, comparable to meropenem (97.0%) and superior to piperacillin-tazobactam (88.0%) 1
- Effectiveness against multidrug-resistant Pseudomonas aeruginosa, inhibiting 92.2% of isolates at ≤16 mg/L 1
Specific Use Cases
For Carbapenem-Resistant Pseudomonas aeruginosa (CRPA)
- Cefepime 2g IV every 8-12 hours is recommended as an alternative treatment option 2
- For difficult-to-treat Pseudomonas aeruginosa (DTR-PA), may be used in combination with other agents 2
For Complicated UTIs/Pyelonephritis
- Cefepime 2g IV every 8-12 hours is recommended for empiric parenteral therapy 2
- Higher dose (2g) is recommended over lower doses studied in clinical trials 2
For Intra-abdominal Infections
- Cefepime 2g IV every 8 hours plus metronidazole 500mg every 6 hours is recommended for healthcare-associated infections or critically ill patients 2, 5
Potential Pitfalls and Considerations
- Resistance development: Monitor local resistance patterns, particularly in healthcare settings with high prevalence of ESBL-producing organisms 5
- Duration of therapy: Limit to 7 days when adequate source control is achieved; extended courses may be needed for immunocompromised patients or inadequate source control 5
- Drug interactions: Avoid concurrent administration with other IV solutions through the same line 4
- Monitoring: Regular assessment of renal function is necessary, with dose adjustments as needed 5, 4
Advantages Over Alternative Therapies
- Carbapenem-sparing option: Helps preserve carbapenems for more resistant infections 1
- Broad spectrum coverage: Active against many ESBL-producing organisms that are resistant to piperacillin-tazobactam 1, 6
- Superior efficacy: Demonstrated better outcomes than piperacillin-tazobactam in complicated UTIs 3
Cefepime-tazobactam represents an important therapeutic option for serious gram-negative infections, particularly in settings with high rates of resistance to other β-lactam/β-lactamase inhibitor combinations.