What is the appropriate dose of Cefepime per dose for a child weighing 35 kilograms?

Cefepime Dosing for a 35 kg Child

For a child weighing 35 kg, the appropriate dose of Cefepime (Megapime) injection is 50 mg/kg/dose given every 8-12 hours, which equals 1750 mg per dose. 1

Dosing Calculation and Rationale

The dosing for Cefepime in pediatric patients is clearly outlined in current guidelines:

• For children beyond the neonatal period: 50 mg/kg/dose 1
• For a 35 kg child: 50 mg/kg × 35 kg = 1750 mg per dose

Frequency of Administration:

• For most infections: Every 12 hours
• For serious or Pseudomonas infections: Every 8 hours 1, 2

Maximum Dose:

• 2000 mg per dose (2 g) should not be exceeded 1, 2

Specific Clinical Scenarios

The dosing frequency may vary based on the type of infection being treated:

1. Standard infections: 50 mg/kg every 12 hours (1750 mg q12h)
2. Severe infections/Pseudomonas infections: 50 mg/kg every 8 hours (1750 mg q8h) 1
3. Prosthetic valve endocarditis: 150 mg/kg/day divided in 3 doses (1750 mg q8h) 1

Administration Considerations

• Administer intravenously over approximately 30 minutes 2
• For severe infections, consider extended infusion over 3-4 hours to improve pharmacodynamic exposure 3
• Continuous infusion may be beneficial for critically ill children with normal or augmented renal clearance 4, 5

Renal Adjustment

If the child has renal impairment, dose adjustment is necessary:

• Normal renal function (CrCL >60 mL/min): No adjustment needed
• Moderate renal impairment (CrCL 30-60 mL/min): Same dose every 12-24 hours
• Severe renal impairment (CrCL <30 mL/min): Same dose every 24 hours 3

Important Clinical Considerations

• Cefepime has a relatively short half-life in children (approximately 1.7-1.9 hours), which supports multiple daily dosing 6
• Underdosing can lead to treatment failure, especially for resistant organisms 3
• For critically ill children, higher doses and/or continuous infusions may be required to achieve therapeutic targets 5
• Therapeutic drug monitoring may be beneficial in critically ill patients to optimize dosing 3

Pitfalls to Avoid

1. Underdosing: Using adult fixed doses rather than weight-based dosing can lead to subtherapeutic levels
2. Failure to adjust for renal function: Can lead to drug accumulation and potential neurotoxicity
3. Inappropriate dosing interval: Once-daily dosing is inadequate due to cefepime's short half-life
4. Not considering the severity of infection: Serious infections require more frequent dosing (q8h)
5. Exceeding maximum recommended dose: Even with weight-based calculations, do not exceed 2g per dose 1, 2

Cefepime pharmacokinetics in children support the 50 mg/kg/dose strategy for patients ≥2 months of age, with frequency adjusted based on infection severity and renal function 6.