Cefepime is Not Available by Mouth for Treating Pseudomonas aeruginosa Wound Infections
Cefepime is not available in oral formulation and must be administered intravenously for treating Pseudomonas aeruginosa wound infections. 1, 2, 3
Rationale for IV-Only Administration
Cefepime can only be administered intravenously for several important reasons:
- Poor oral bioavailability of cephalosporins against Pseudomonas infections
- Inadequate penetration into wound tissues with oral formulations
- Pseudomonas aeruginosa requires high drug concentrations that can only be achieved with IV administration
Recommended IV Dosing for Pseudomonas Wound Infections
For treating Pseudomonas aeruginosa wound infections, the recommended IV dosing is:
- Adults: 2 g IV every 8-12 hours 1, 2, 3
- Maximum daily dose: 6 g 1
- Pediatric patients: 50 mg/kg IV every 8 hours for Pseudomonas infections 1
Alternative Oral Options
When oral therapy is required for Pseudomonas aeruginosa infections (after initial IV therapy and clinical improvement):
Pharmacodynamic Considerations
The efficacy of cefepime against Pseudomonas aeruginosa is dependent on:
- Time above MIC (T>MIC) - ideally >60% of the dosing interval 4
- Higher doses and/or more frequent dosing may be needed for resistant strains
- Extended or continuous infusion may improve efficacy 5, 6
Monitoring and Duration
- Monitor clinical response within 48-72 hours of initiating therapy 2
- Standard treatment duration: 7-10 days 2, 3
- Consider longer duration for complicated infections or immunocompromised patients
Important Considerations
- Renal dose adjustment is required for creatinine clearance ≤60 mL/min 3
- Combination therapy with an aminoglycoside (e.g., tobramycin) or fluoroquinolone may be beneficial for severe infections 2
- Source control (e.g., debridement, drainage) is essential for wound infections
Pitfalls to Avoid
- Do not attempt oral cefepime administration as it does not exist in oral form
- Do not underdose cefepime against Pseudomonas as it may lead to treatment failure
- Avoid prolonged therapy without clear indication as it increases risk of resistance
- Do not rely on monotherapy for severe or deep-seated Pseudomonas infections
In conclusion, cefepime must be administered intravenously for Pseudomonas aeruginosa wound infections, with appropriate dosing based on infection severity, patient characteristics, and renal function.