What is the recommended dosing of cefepime (Fourth-generation cephalosporin) for urinary tract infections (UTIs)?

Cefepime Dosing for Urinary Tract Infections

For urinary tract infections, cefepime should be dosed at 0.5-1 g IV every 12 hours for mild to moderate uncomplicated or complicated UTIs, and 2 g IV every 12 hours for severe uncomplicated or complicated UTIs, with treatment duration of 7-10 days. 1

Dosing Recommendations Based on UTI Severity

• For mild to moderate uncomplicated or complicated UTIs: 0.5-1 g IV every 12 hours for 7-10 days 1
• For severe uncomplicated or complicated UTIs: 2 g IV every 12 hours for 10 days 1
• For UTIs caused by Pseudomonas aeruginosa: 2 g IV every 8 hours 2, 1

Dosing Adjustments for Special Populations

Renal Impairment

• Dose adjustment is required for patients with creatinine clearance ≤60 mL/min 1
• Failure to adjust doses in patients with renal impairment has been associated with neurotoxicity, particularly in geriatric patients 1

Pediatric Patients

• For children 2 months to 16 years: 50 mg/kg IV every 12 hours 1
• Only use full 1 g or 2 g doses in pediatric patients who require the entire dose 1

Clinical Evidence Supporting Efficacy

• Clinical trials have demonstrated that cefepime at doses of 500 mg every 12 hours achieved satisfactory clinical response in 89% of patients with complicated UTIs and 92% of patients with uncomplicated UTIs 3
• Bacterial eradication rates were 85% for both complicated and uncomplicated UTIs with this dosing regimen 3
• Lower dosage of cefepime (1 g twice daily) has shown 94% clinical cure rates in UTIs, including those with associated bacteremia 4

Comparison with Other Antimicrobials

• Cefepime has demonstrated comparable efficacy to ceftazidime in the treatment of both complicated and uncomplicated UTIs 3
• For UTIs caused by carbapenem-resistant Pseudomonas aeruginosa (CRPA), cefepime 2 g IV every 8-12 hours is recommended when susceptibility is confirmed 2

Administration Considerations

• Administer intravenously over approximately 30 minutes 1
• Do not force thaw frozen container by immersion in water baths or by microwave irradiation 1
• For empiric therapy of complicated UTIs in patients with risk factors such as diabetes mellitus and chronic kidney disease, ensure appropriate coverage against resistant organisms 5

Monitoring and Follow-up

• Monitor for adverse reactions, which most commonly include headache, diarrhea, and vomiting 1, 3
• Local reactions, positive Coombs' test, decreased phosphorous, increased ALT and AST, increased PT and PTT, and rash have been reported at rates ≥1% 1
• At the highest dose (2 g every 8 hours), higher incidence of adverse reactions including rash, diarrhea, nausea, vomiting, pruritus, fever, and headache have been observed 1

Important Considerations and Caveats

• Cross-hypersensitivity among beta-lactam antibiotics may occur in up to 10% of patients with a history of penicillin allergy 1
• If an allergic reaction occurs, discontinue the drug immediately 1
• Monitor for Clostridioides difficile-associated diarrhea during and after treatment 1
• When used concomitantly with aminoglycosides, there is increased potential for nephrotoxicity and ototoxicity 1
• Nephrotoxicity has been reported following concomitant administration with potent diuretics such as furosemide 1