Cefepime IV Dosing for Complicated UTI

For complicated urinary tract infections, cefepime should be administered at a dose of 1-2 g IV every 12 hours for 7-10 days. 1

Standard Dosing Regimen

For mild to moderate complicated UTIs, cefepime 0.5-1 g IV every 12 hours for 7-10 days is recommended 1
For severe complicated UTIs, cefepime 2 g IV every 12 hours for 10 days is the appropriate dosage 1
For complicated UTIs due to Pseudomonas aeruginosa, a higher dosage of cefepime 2 g IV every 8 hours is recommended 2

For patients with creatinine clearance 30-60 mL/min: reduce to 1-2 g IV every 24 hours 1
For patients with creatinine clearance 11-29 mL/min: reduce to 0.5-1 g IV every 24 hours 1
For patients with creatinine clearance <11 mL/min: reduce to 0.25-0.5 g IV every 24 hours 1
For patients on hemodialysis: 1 g on day 1, then 500 mg every 24 hours thereafter (administer after hemodialysis on dialysis days) 1
For patients on CAPD: 1-2 g every 48 hours 1

Standard duration for complicated UTIs is 7-10 days 1
For complicated UTIs with concurrent bacteremia, extend treatment to 10-14 days 2
The suggested treatment duration is 5-10 days for uncomplicated cases, but complicated UTIs generally require the full 7-10 day course 2

Cefepime is indicated for both uncomplicated and complicated UTIs caused by E. coli, K. pneumoniae, or P. mirabilis, including cases with concurrent bacteremia 1
For complicated UTIs due to carbapenem-resistant Pseudomonas aeruginosa (CRPA) that remains susceptible to cefepime, a dose of 2 g IV every 8-12 hours is recommended 2
Clinical trials have shown cefepime to be effective for complicated UTIs with clinical response rates of 89% and bacterial eradication rates of 85% 3
Recent studies show that newer combinations like cefepime-taniborbactam have superior efficacy compared to carbapenems for complicated UTIs, suggesting cefepime remains an important backbone for UTI treatment 4

For multidrug-resistant organisms, alternative options include ceftazidime-avibactam 2.5 g IV q8h or ceftolozane/tazobactam 1.5-3 g IV q8h 5
For difficult-to-treat Pseudomonas aeruginosa, ceftolozane/tazobactam 1.5-3 g IV q8h or ceftazidime/avibactam 2.5 g IV q8h are recommended alternatives 2
Fluoroquinolones (ciprofloxacin 400 mg IV q8h or levofloxacin 750 mg IV daily) can be considered as alternatives if the pathogen is susceptible 2

Obtain urine culture before initiating therapy to guide definitive treatment 6
Monitor renal function throughout treatment as dosage adjustments are necessary for renal impairment 1
Consider follow-up cultures after completion of therapy to confirm eradication, especially in complicated cases 6
Monitor for adverse effects, which most commonly include headache, diarrhea, and vomiting 3