Cefepime Dosing for UTI in Patients with Impaired Renal Function
For patients with impaired renal function, cefepime dosing for UTI should be adjusted based on creatinine clearance, with 500 mg every 24 hours for CrCl 11-29 mL/min and 250 mg every 24 hours for CrCl less than 11 mL/min. 1
Dosing Recommendations Based on Renal Function
The FDA-approved cefepime dosing for UTI varies by severity and renal function:
Normal Renal Function (CrCl > 60 mL/min):
- Mild to moderate uncomplicated/complicated UTI: 0.5-1 g IV every 12 hours for 7-10 days
- Severe uncomplicated/complicated UTI: 2 g IV every 12 hours for 10 days 1
Impaired Renal Function:
| Creatinine Clearance | Mild-Moderate UTI (500 mg q12h) | Severe UTI (2 g q12h) |
|---|---|---|
| 30-60 mL/min | 500 mg every 24 hours | 2 g every 24 hours |
| 11-29 mL/min | 500 mg every 24 hours | 1 g every 24 hours |
| <11 mL/min | 250 mg every 24 hours | 500 mg every 24 hours |
| CAPD | 500 mg every 48 hours | 2 g every 48 hours |
| Hemodialysis | 1 g on day 1, then 500 mg q24h | 1 g every 24 hours |
Special Considerations for Dialysis Patients
Hemodialysis:
- Approximately 68% of cefepime is removed during a 3-hour dialysis session
- Administer cefepime following hemodialysis on dialysis days
- Recommended dose: 1 g on day 1, then 500 mg every 24 hours 1, 2
Continuous Ambulatory Peritoneal Dialysis (CAPD):
- Administer 500 mg every 48 hours for mild-moderate UTI
- Administer 2 g every 48 hours for severe UTI 1
Calculating Creatinine Clearance
When only serum creatinine is available, use the Cockcroft-Gault equation to estimate creatinine clearance:
- Males: CrCl (mL/min) = Weight (kg) × (140 – age) / (72 × serum creatinine [mg/dL])
- Females: CrCl (mL/min) = 0.85 × male value 1
Duration of Treatment
- Mild to moderate uncomplicated/complicated UTI: 7-10 days
- Severe uncomplicated/complicated UTI: 10 days 1
Monitoring Recommendations
- Assess clinical response within 48-72 hours and adjust therapy based on culture results 3
- For dialysis patients, monitor drug levels according to local policy thresholds 3
- Be aware of drug accumulation between dialysis sessions 3
- Consider timing of antibiotic administration relative to dialysis sessions 3
Clinical Efficacy
Cefepime has demonstrated high efficacy in the treatment of UTIs, with clinical response rates of 89-92% and bacterial eradication rates of 85% in both complicated and uncomplicated UTIs 4.
Potential Pitfalls and Caveats
- Avoid using standard dosing regimens in dialysis patients, as dialysis significantly alters drug clearance 3
- The National Kidney Foundation advises against relying on creatinine-based equations to estimate renal function in dialysis patients 3
- Consider obtaining urine culture before initiating antibiotics 3
- Consider blood cultures if the patient shows signs of systemic infection/sepsis 3
- Most common adverse events include headache, diarrhea, and vomiting 4