Recommended Dosage of Fetroja (Cefiderocol) for Complicated Urinary Tract Infections
The recommended dosage of Fetroja (cefiderocol) for complicated urinary tract infections is 2 grams administered every 8 hours by intravenous infusion over 3 hours in adults with creatinine clearance of 60 to 119 mL/min, with a recommended treatment duration of 7 to 14 days. 1
Standard Dosing Regimen
- 2 grams IV every 8 hours (administered over 3 hours)
- Duration: 7 to 14 days, guided by patient's clinical status
- For patients with normal renal function (CrCl 60-119 mL/min)
Renal Dosage Adjustments
Fetroja requires dose adjustment based on renal function:
For patients with reduced renal function:
- CrCl 30-59 mL/min: 1.5 grams every 8 hours (3-hour infusion)
- CrCl 15-29 mL/min: 1 gram every 8 hours (3-hour infusion)
- CrCl <15 mL/min: 0.75 grams every 12 hours (3-hour infusion) 1
For patients with augmented renal function:
- CrCl ≥120 mL/min: 2 grams every 6 hours (3-hour infusion) 1
For patients on hemodialysis:
- 0.75 grams every 12 hours (3-hour infusion)
- Administer immediately after hemodialysis completion 1
For patients on continuous renal replacement therapy (CRRT):
Dosage based on effluent flow rate:
- ≤2 L/hr: 1.5 grams every 12 hours
- 2.1-3 L/hr: 2 grams every 12 hours
- 3.1-4 L/hr: 1.5 grams every 8 hours
- ≥4.1 L/hr: 2 grams every 8 hours 1
Clinical Efficacy
Cefiderocol has demonstrated efficacy in complicated UTIs, with clinical trials showing:
- 73% composite outcome (clinical and microbiological eradication) with cefiderocol versus 55% with imipenem-cilastatin in patients with complicated UTIs 2
- Effective against multidrug-resistant Gram-negative pathogens including Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, and Enterobacter cloacae complex 3
Administration Considerations
- Reconstitute with 10 mL of either 0.9% sodium chloride or 5% dextrose
- Further dilute in 100 mL of 0.9% sodium chloride or 5% dextrose
- Administer as 3-hour IV infusion to maximize time above MIC 1
Common Adverse Effects
- Gastrointestinal disorders are most common: diarrhea, constipation, nausea, vomiting, and abdominal pain 3, 4
- Monitor for hypersensitivity reactions and Clostridioides difficile-associated diarrhea
Important Considerations
- Obtain cultures before initiating therapy to guide treatment 5
- Consider local resistance patterns when selecting empiric therapy 5
- Pharmacodynamic target is 100% fT>MIC, which is achieved with the recommended dosing regimen for most patients 6
- Reserve for patients with limited treatment options due to resistance, as cefiderocol should be used judiciously to prevent development of resistance 4
Monitoring
- Assess clinical response within 48-72 hours of treatment initiation
- Monitor renal function throughout therapy as dosage adjustments may be needed if renal function changes
- Evaluate for adverse effects, particularly gastrointestinal symptoms