What is the coverage and dosage of cefepime for various infections?

Cefepime Coverage and Dosage for Various Infections

Cefepime is a fourth-generation cephalosporin with broad-spectrum coverage that can be used at a dosage of 1-2g IV every 8-12 hours for most infections, with higher doses (2g every 8 hours) recommended for Pseudomonas aeruginosa infections.

Antimicrobial Spectrum

Cefepime has activity against:

• Gram-positive organisms:

  • Streptococcus pneumoniae (including penicillin-sensitive, -intermediate and -resistant strains)
  • Staphylococcus aureus (methicillin-susceptible only)

• Gram-negative organisms:

  • Pseudomonas aeruginosa
  • Enterobacteriaceae (including some ESBL-producing strains)
  • Haemophilus influenzae
  • HACEK group organisms

• Key advantages:

  • Stable against many common plasmid- and chromosome-mediated beta-lactamases
  • Poor inducer of AmpC beta-lactamases
  • Retains activity against some Enterobacteriaceae resistant to third-generation cephalosporins

Dosage Recommendations by Infection Type

Respiratory Tract Infections

• Moderate to severe pneumonia: 1-2g IV every 8-12 hours for 10 days 1
• For Pseudomonas aeruginosa pneumonia: 2g IV every 8 hours 1
• For carbapenem-resistant Pseudomonas aeruginosa: 2g IV every 8-12 hours 2

Urinary Tract Infections

• Mild to moderate uncomplicated/complicated UTI: 0.5-1g IV every 12 hours for 7-10 days 1
• Severe uncomplicated/complicated UTI: 2g IV every 12 hours for 10 days 1

Skin and Skin Structure Infections

• Moderate to severe uncomplicated infections: 2g IV every 12 hours for 10 days 1

Intra-abdominal Infections

• Complicated intra-abdominal infections: 2g IV every 8-12 hours for 7-10 days (in combination with metronidazole) 1

Febrile Neutropenia

• Empiric therapy: 2g IV every 8 hours until resolution of neutropenia 1

Endocarditis (HACEK organisms)

• Native and prosthetic valve endocarditis: Ceftriaxone is preferred, but cefepime can be substituted 2

Pediatric Dosing

• Children up to 40kg: 50 mg/kg/dose every 12 hours (every 8 hours for febrile neutropenia) 1

Special Considerations

Renal Dosage Adjustment

• Dosage adjustment required for patients with creatinine clearance ≤60 mL/min 1

Limitations and Warnings

1. ESBL-producing organisms:

   • Inconsistent results against ESBL-producing Enterobacteriaceae
   • Higher mortality observed with cefepime when MICs are in the susceptible dose-dependent range (≥8 μg/mL) 3
   • Carbapenems preferred for confirmed ESBL infections

2. Multidrug-resistant organisms:

   • For carbapenem-resistant organisms, combination therapy may be needed
   • Not recommended as monotherapy for difficult-to-treat Pseudomonas aeruginosa (DTR-PA) 2

Administration

• Administer intravenously over approximately 30 minutes 1
• Duration of therapy depends on infection site and severity (typically 7-14 days)

Clinical Pearls

• Cefepime is particularly valuable for empiric therapy when Pseudomonas coverage is needed but carbapenem-sparing approaches are preferred
• For severe infections with suspected resistant pathogens, consider combination therapy initially until susceptibilities are known
• Local resistance patterns should guide empiric therapy decisions
• De-escalate to more targeted therapy once culture results are available

Cefepime remains a reliable option for many serious infections, but its use should be guided by local susceptibility patterns and patient-specific factors to optimize outcomes and minimize resistance development.