Cefepime IV Dosing Recommendations
The recommended IV dosing for cefepime in adults with normal renal function is 1-2 g every 8-12 hours, with dose adjustments required for patients with renal impairment. 1
Standard Dosing for Adults with Normal Renal Function
For adults with creatinine clearance >60 mL/min, the following dosing regimens are recommended based on infection type 1:
- Moderate to severe pneumonia: 1-2 g IV every 8-12 hours for 10 days
- Empiric therapy for febrile neutropenic patients: 2 g IV every 8 hours for 7 days
- Mild to moderate UTIs: 0.5-1 g IV every 12 hours for 7-10 days
- Severe UTIs: 2 g IV every 12 hours for 10 days
- Moderate to severe skin/skin structure infections: 2 g IV every 12 hours for 10 days
- Complicated intra-abdominal infections: 2 g IV every 8-12 hours for 7-10 days
For critically ill patients with normal renal function, higher doses of 2 g every 8 hours are often recommended due to increased clearance and volume of distribution 2
Administration should be given intravenously over approximately 30 minutes 1
Dosing in Renal Impairment
- For patients with creatinine clearance ≤60 mL/min, dose adjustments are required as follows 1:
| Creatinine Clearance | 500 mg dose | 1 g dose | 2 g dose | 2 g (q8h) dose |
|---|---|---|---|---|
| 30-60 mL/min | q24h | q24h | q24h | q12h |
| 11-29 mL/min | q24h | q24h | q24h | q24h |
| <11 mL/min | 250 mg q24h | 250 mg q24h | 500 mg q24h | 1 g q24h |
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 continuous ambulatory peritoneal dialysis (CAPD): 500 mg every 48 hours for standard dose, or 2 g every 48 hours for high dose 1
Higher doses in patients with severe renal dysfunction may increase the risk of cefepime-associated neurotoxicity, which primarily manifests as altered mental status 3
Pediatric Dosing
For pediatric patients (2 months to 16 years) with normal renal function 1:
- Standard dose: 50 mg/kg every 12 hours (not to exceed 2 g per dose)
- For moderate to severe pneumonia due to P. aeruginosa or febrile neutropenia: 50 mg/kg every 8 hours
Pediatric dose adjustments for renal impairment should be proportional to adult adjustments 1
Special Considerations
Monitor for neurotoxicity (confusion, encephalopathy, myoclonus, seizures) especially in patients with renal dysfunction 3
For patients with augmented renal clearance (CrCl 120-180 mL/min), consider prolonged infusion (over 4 hours) of the standard dose to maintain adequate drug levels 4
In critically ill patients with fluctuating renal function, therapeutic drug monitoring should be considered to optimize dosing 2
For patients receiving continuous renal replacement therapy, dosing should be individualized based on the specific modality and flow rates 5
By following these dosing recommendations and making appropriate adjustments based on renal function, clinicians can optimize cefepime therapy while minimizing the risk of adverse effects.