What is the recommended dosage and treatment duration for Cefepime (Cefepime) in patients with severe infections, including pneumonia and complicated urinary tract infections?

Cefepime Dosage and Treatment Duration for Severe Infections

For severe infections including pneumonia and complicated urinary tract infections, cefepime should be administered at a dose of 1-2 g IV every 8-12 hours for pneumonia and 2 g IV every 12 hours for severe UTIs, with treatment durations of 10 days for pneumonia and 10 days for severe UTIs. 1

Dosage Recommendations by Infection Type

Pneumonia

• For moderate to severe pneumonia, including those caused by Pseudomonas aeruginosa, Klebsiella pneumoniae, or Enterobacter species: 1-2 g IV every 8-12 hours for 10 days 1
• For pneumonia due to Pseudomonas aeruginosa specifically: 2 g IV every 8 hours is recommended to ensure adequate coverage 1, 2

Complicated Urinary Tract Infections

• For mild to moderate complicated UTIs: 0.5-1 g IV every 12 hours for 7-10 days 1
• For severe complicated UTIs: 2 g IV every 12 hours for 10 days 1
• Treatment duration should typically be 5-7 days for complicated UTIs, with longer durations (up to 10 days) reserved for more severe infections 2

Intra-abdominal Infections

• For complicated intra-abdominal infections (used in combination with metronidazole): 2 g IV every 8-12 hours for 7-10 days 1, 2
• The combination with metronidazole is essential to provide anaerobic coverage for intra-abdominal infections 2

Dosage Adjustments for Renal Impairment

Cefepime dosage must be adjusted based on creatinine clearance (CrCl) 1:

• CrCl 30-60 mL/min:

  • 2 g every 24 hours (for severe infections normally requiring 2 g every 12 hours)
  • 2 g every 12 hours (for severe infections normally requiring 2 g every 8 hours)
  • 1 g every 24 hours (for moderate infections normally requiring 1 g every 12 hours)

• CrCl 11-29 mL/min:

  • 1 g every 24 hours (for severe infections normally requiring 2 g every 12 hours)
  • 2 g every 24 hours (for severe infections normally requiring 2 g every 8 hours)
  • 500 mg every 24 hours (for moderate infections normally requiring 1 g every 12 hours)

• CrCl <11 mL/min:

  • 500 mg every 24 hours (for severe infections normally requiring 2 g every 12 hours)
  • 1 g every 24 hours (for severe infections normally requiring 2 g every 8 hours)
  • 250 mg every 24 hours (for moderate infections normally requiring 1 g every 12 hours)

Administration Method

• Cefepime should be administered intravenously over approximately 30 minutes 1
• For Pseudomonas aeruginosa infections with high MICs, extended infusion of beta-lactams is recommended to optimize pharmacodynamic parameters 2

Clinical Efficacy

• Cefepime has demonstrated efficacy comparable to other broad-spectrum antibiotics in the treatment of severe infections 3
• In comparative trials, cefepime 1-2 g administered twice daily showed similar efficacy to ceftazidime, ceftriaxone, and cefotaxime for respiratory tract infections, UTIs, and intra-abdominal infections 4
• For patients with pneumonia who failed to respond to previous antibacterial therapy with penicillins or other cephalosporins, cefepime has shown good response rates 5

Antimicrobial Spectrum

• Cefepime has excellent activity against many Gram-negative pathogens, including Pseudomonas aeruginosa, similar to ceftazidime 5
• It also has good activity against Gram-positive organisms including Staphylococcus aureus and penicillin-sensitive, -intermediate and -resistant Streptococcus pneumoniae 5
• Importantly, cefepime is stable against many common plasmid- and chromosome-mediated beta-lactamases and is a poor inducer of AmpC beta-lactamases, making it effective against Enterobacteriaceae resistant to third-generation cephalosporins 5, 6

Common Pitfalls and Considerations

• For multidrug-resistant organisms, alternative options should be considered:

  • For Carbapenem-resistant Enterobacterales (CRE): ceftazidime-avibactam 2.5 g IV q8h, meropenem-vaborbactam 4 g IV q8h, or imipenem-cilastatin-relebactam 1.25 g IV q6h 2
  • For difficult-to-treat Pseudomonas: higher doses of cefepime (2 g every 8 hours) or alternatives like ceftolozane/tazobactam 2

• Ensure adequate source control (e.g., drainage of abscesses, relief of obstruction) for optimal treatment outcomes, particularly in complicated UTIs and intra-abdominal infections 2

• For patients with bacteremia associated with pneumonia or UTI, extend treatment duration to 10-14 days 2

• Monitor for adverse events, which are typically mild to moderate and include rash, diarrhea, pruritus, nausea, and headache 5, 4