What is the recommended dose of Cefepime (Cefepime) for a patient with severe impaired renal function (creatinine clearance of 22)?

Cefepime Dosing for Creatinine Clearance of 22 mL/min

For patients with creatinine clearance of 22 mL/min, the recommended dose of cefepime is 1 gram every 24 hours. 1

Dosing Considerations in Renal Impairment

• Cefepime is primarily excreted by the kidneys, requiring dose adjustment in patients with renal impairment to prevent drug accumulation and potential toxicity 1
• A creatinine clearance of 22 mL/min represents moderate to severe renal impairment, necessitating significant dose reduction from the standard dosing regimen 1
• According to the FDA drug label, patients with creatinine clearance less than or equal to 60 mL/min require dosage adjustment to compensate for slower renal elimination 1

Specific Dosing Recommendations

• For patients with creatinine clearance between 11-29 mL/min, the recommended dose is 1 gram every 24 hours 1
• This represents a 50% reduction in daily dose compared to patients with normal renal function who typically receive 1-2 grams every 12 hours 1
• The extended dosing interval (24 hours instead of 12 hours) helps maintain therapeutic drug levels while preventing toxic accumulation 2

Monitoring Considerations

• Patients with renal impairment receiving cefepime should be carefully monitored for signs of neurotoxicity, which may include:

  • Confusion, altered mental status, or disorientation 3
  • Myoclonus or muscle jerks 2
  • Non-convulsive seizures 2
  • Encephalopathy 1

• Plasma levels of cefepime can vary significantly between individuals with renal impairment, with up to 40-fold differences in trough concentrations reported in some studies 2

Risks of Inappropriate Dosing

• Serious adverse events have been reported in patients with renal impairment given unadjusted doses of cefepime, including life-threatening or fatal occurrences of encephalopathy, myoclonus, and seizures 1
• Studies have shown that even with dose adjustment, approximately 10% of patients with severe renal impairment (CrCl < 30 mL/min) may still experience cefepime accumulation with trough concentrations of 20-30 mg/L 2
• Symptoms of cefepime overdose in renal impairment include encephalopathy, confusion, hallucinations, stupor, coma, myoclonus, seizures, and neuromuscular excitability 1

Special Considerations

• Hemodialysis contributes to cefepime clearance, so for patients on dialysis, cefepime should be administered after dialysis sessions 4
• For elderly patients with renal impairment, extra caution is warranted as they may be at higher risk for adverse effects due to age-related decreases in renal function 1
• If signs of neurotoxicity develop, prompt discontinuation of cefepime should be considered, as symptoms typically resolve after drug cessation 5

Common Pitfalls to Avoid

• Failing to adjust cefepime dosage in patients with renal impairment, which can lead to drug accumulation and neurotoxicity 1, 2
• Not recognizing early signs of cefepime-associated neurotoxicity, which may be subtle and mistaken for other conditions common in critically ill patients 3
• Inadequate monitoring of renal function during treatment, as changes in renal function may necessitate further dose adjustments 1
• Using standard dosing in elderly patients without considering age-related decreases in renal function 1