Cefepime Dosage for Wound Infections
For adult patients with wound infections, the recommended dosage of cefepime is 2 grams intravenously every 12 hours for 10 days. 1, 2
Adult Dosing
- For uncomplicated skin and skin structure infections: 2 g IV every 12 hours for 10 days 2
- For complicated intra-abdominal infections (used in combination with metronidazole): 2 g IV every 8-12 hours for 7-10 days 2
- For mixed infections in skin, fascia, and muscle: 2 g IV every 8-12 hours (if Pseudomonas aeruginosa is suspected, use 2 g IV every 8 hours) 1
Pediatric Dosing
- Neonates ≤14 days of age: 30 mg/kg every 12 hours 1
- Infants >14 days of age and children ≤40 kg: 50 mg/kg every 12 hours 1
- For serious Pseudomonas infections: 50 mg/kg/dose IV every 8 hours (maximum 2000 mg/dose) 1
Dosage Adjustments for Renal Impairment
Dosage adjustment is required for patients with creatinine clearance (CrCL) ≤60 mL/min 2:
- CrCL 30-60 mL/min: 2 g IV every 24 hours
- CrCL 11-29 mL/min: 1 g IV every 24 hours
- CrCL ≤10 mL/min: 500 mg IV every 24 hours
Clinical Efficacy in Wound Infections
- Cefepime has demonstrated 90% success rates in treating skin and skin structure infections in clinical trials 3
- When combined with metronidazole, cefepime showed superior clinical cure rates (88%) compared to imipenem-cilastatin (76%) for complicated intra-abdominal infections 4
- Cefepime is effective against both gram-positive and gram-negative pathogens commonly found in wound infections 5, 6
Administration Guidelines
- Administer intravenously over approximately 30 minutes 2
- For pediatric patients, ensure the dose is calculated based on weight and age 1
- Do not force thaw frozen container by immersion in water baths or by microwave irradiation 2
Important Considerations and Precautions
- Cross-hypersensitivity among beta-lactam antibiotics may occur in up to 10% of patients with a history of penicillin allergy 2
- Monitor for neurotoxicity, especially in patients with renal impairment 2
- Watch for Clostridioides difficile-associated diarrhea during treatment 2
- The most common adverse reactions (≥1%) include local reactions, positive Coombs' test, decreased phosphorous, increased ALT and AST, increased PT and PTT, and rash 2
Special Populations
- For immunocompromised patients or those with neutropenic fever: 2 g IV every 8 hours 2
- For elderly patients, consider renal function before determining dosage, as serious adverse reactions have occurred in geriatric patients with renal impairment given unadjusted doses 2
Cefepime is a fourth-generation cephalosporin with a broad spectrum of activity against both gram-positive and gram-negative bacteria, making it an excellent choice for wound infections where mixed flora may be present 5.