Cefepime Dosing in Adults with Normal Renal Function
For adults with normal renal function (creatinine clearance >60 mL/min), the recommended dosing for cefepime is 1-2 g IV every 8-12 hours, with specific dosing dependent on the type and severity of infection. 1
Standard Dosing Regimens by Infection Type
- Moderate to Severe Pneumonia: 1-2 g IV every 8-12 hours for 10 days (for Pseudomonas aeruginosa infections, use 2 g IV every 8 hours) 1
- Empiric therapy for febrile neutropenia: 2 g IV every 8 hours for 7 days or until resolution of neutropenia 1
- Mild to Moderate UTIs: 0.5-1 g IV every 12 hours for 7-10 days 1
- Severe UTIs: 2 g IV every 12 hours for 10 days 1
- Moderate to Severe Skin/Soft Tissue Infections: 2 g IV every 12 hours for 10 days 1
- Complicated Intra-abdominal Infections: 2 g IV every 8-12 hours for 7-10 days (used in combination with metronidazole) 1
Administration Considerations
- Standard administration is via intravenous infusion over approximately 30 minutes 1
- Extended or continuous infusions may be beneficial for infections due to bacteria with high MICs to increase probability of achieving pharmacokinetic/pharmacodynamic targets 2
- For serious infections such as bacteremia, infective endocarditis, and pneumonia, higher doses within the recommended range (2 g) should be considered 2
Pharmacokinetic Properties
- Cefepime exhibits linear pharmacokinetic behavior with an elimination half-life of approximately 2-2.5 hours in patients with normal renal function 3, 4
- Volume of distribution is approximately 0.2 L/kg in adults with normal renal function 3
- Protein binding is relatively low at 16-20% 3, 4
- Approximately 85% of the dose is excreted unchanged in the urine 3
Safety Considerations
- Cefepime has relatively high pro-convulsive activity compared to other beta-lactams 2
- Monitor for neurological adverse effects, particularly in patients with renal impairment 3
- The most common adverse events include rash (1.8%), diarrhea (1.7%), headache (2.4%), and nausea (1.8%) 5
Special Clinical Scenarios
- For multidrug-resistant infections, higher doses (2 g every 8 hours) and extended infusions may be preferred 2, 3
- Cefepime is stable against many common plasmid- and chromosome-mediated beta-lactamases, making it useful for infections resistant to earlier generation cephalosporins 6, 7
- Therapeutic drug monitoring may be beneficial in critically ill patients, those with life-threatening infections, or infections with more resistant pathogens 3