What is the recommended dosage of Cefepime (Intravenous Cefepime) for infections?

Cefepime Dosage Recommendations for Infections

The recommended dosage of intravenous cefepime for adults with normal renal function is 2 g every 8-12 hours for most serious infections, while pediatric patients should receive 50 mg/kg every 12 hours (every 8 hours for febrile neutropenia). 1

Adult Dosing

Standard Dosing by Infection Type

• Moderate to Severe Pneumonia: 1-2 g every 8-12 hours for 10 days 1
• Empiric therapy for febrile neutropenic patients: 2 g every 8 hours for 7 days or until resolution of neutropenia 1
• Mild to Moderate UTIs: 0.5-1 g every 12 hours for 7-10 days 1
• Severe UTIs: 2 g every 12 hours for 10 days 1
• Moderate to Severe Skin/Skin Structure Infections: 2 g every 12 hours for 10 days 1
• Complicated Intra-abdominal Infections: 2 g every 8-12 hours for 7-10 days (used with metronidazole) 1

Important Considerations for Adult Dosing

• For Pseudomonas aeruginosa infections, use the higher dose of 2 g every 8 hours 1
• Higher doses may be needed in critically ill patients with preserved renal function due to increased clearance and volume of distribution 2
• Prolonged or continuous infusions may be beneficial for infections caused by bacteria with high MICs 2

Pediatric Dosing

Standard Pediatric Dosing

• Children (2 months to 16 years): 50 mg/kg every 12 hours 1, 3
• For febrile neutropenia: 50 mg/kg every 8 hours 1
• Maximum individual dose: 2 g 3

Special Pediatric Populations

• Infants >14 days of age and children ≤40 kg: 50 mg/kg every 12 hours 2
• Neonates ≤14 days of age: 30 mg/kg every 12 hours 2

Dosage Adjustments for Renal Impairment

Cefepime requires dose adjustment in patients with renal impairment:

• Significant linear relationship exists between total body clearance and creatinine clearance 4
• Dosage should be reduced in proportion to the decline in creatinine clearance 4
• For patients on continuous renal replacement therapy (CRRT), higher doses may be needed than typically recommended in clinical resources 5

Pharmacokinetic Considerations

• Elimination half-life is approximately 2 hours in patients with normal renal function 6, 3
• Volume of distribution at steady state in healthy adults is about 20.5 liters 4
• In pediatric patients, elimination half-life averages 1.7 hours 3
• Bioavailability after intramuscular administration averages 82% 3

Clinical Pearls and Pitfalls

Potential Pitfalls

• Underdosing in critically ill patients: Standard doses may be insufficient in critically ill patients with preserved renal function due to increased clearance and volume of distribution 2
• Neurotoxicity risk: When cefepime concentrations exceed eight times the MIC, there is risk of neurological deterioration, particularly in ICU patients 2
• Inadequate dosing for resistant organisms: For infections caused by bacteria with high MICs, standard dosing may not achieve adequate drug concentrations 2

Monitoring Recommendations

• Consider therapeutic drug monitoring in critically ill patients to ensure optimal dosing 2
• Monitor renal function regularly to adjust dosing as needed 4
• For patients receiving aminoglycosides with cefepime, individualized daily administration according to lean body mass and estimated extracellular fluid volume is preferred 2

By following these evidence-based dosing recommendations and considering patient-specific factors like renal function and severity of infection, clinicians can optimize cefepime therapy to improve outcomes while minimizing adverse effects.