Cefeperazone Intravenous Dosage
For adults with normal renal and hepatic function, administer cefeperazone 2-4 g intravenously every 12 hours, with doses up to 12 g daily in severe infections. 1, 2
Standard Adult Dosing
- Typical dose range: 2-4 g IV every 12 hours for most infections 1, 2
- Severe infections: Up to 12 g daily may be administered in divided doses 2
- Administration methods: Can be given as rapid IV injection (over 3-5 minutes), short infusion (15-30 minutes), or extended infusion (up to 2 hours) 2
Dosing by Clinical Indication
Multidrug-Resistant Gram-Negative Infections
- For carbapenem-resistant Pseudomonas aeruginosa (CRPA) susceptible to cefoperazone: 3-4 g IV every 6 hours may be considered 3
- Treatment duration: 5-10 days for complicated urinary tract infections and intra-abdominal infections; 10-14 days for hospital-acquired pneumonia and bloodstream infections 3
Complicated Intra-Abdominal Infections
- Standard dosing of 2 g IV every 8-12 hours is appropriate for adults 3
- Should be combined with metronidazole for anaerobic coverage in intra-abdominal infections 3
Pharmacokinetic Considerations
- Peak serum levels: 202-375 mcg/mL after 2 g IV dose (varies by infusion duration) 2, 4
- Half-life: 1.6-2.4 hours in normal subjects 2, 4
- Protein binding: 90% bound to serum proteins 4
- Elimination: Primarily biliary excretion (60-70%); only 15-36% excreted renally 2, 4
Dosing in Renal Impairment
No dosage adjustment is required for renal impairment alone, as cefeperazone is primarily eliminated via biliary excretion. 1, 4, 5
- Serum half-life increases minimally in severe renal failure (mean 6.6 hours vs 2 hours in normal function) 1
- Standard doses of 2-4 g daily do not lead to drug accumulation even in severe renal failure 1
- In functionally anephric patients, the half-life extends to approximately 3 hours but remains clinically manageable 6
- Hemodialysis does not significantly remove cefeperazone, so no supplemental dosing is needed post-dialysis 6
Dosing in Hepatic Impairment
Severe hepatic dysfunction requires dosage reduction due to 2-4 fold increase in half-life. 4, 5
- In severe biliary obstruction, over 90% of the drug shifts to renal excretion 4
- Despite prolonged half-life, drug accumulation was not observed with 1 g every 12 hours in hepatic dysfunction 5
- Major dosage modification is only required with concomitant renal AND hepatic dysfunction 5
Pediatric Dosing
- Neonates and infants: Specific dosing not well-established in provided guidelines; infectious disease consultation recommended 3
- Children: 150-300 mg/kg/day IV divided every 6-8 hours for serious infections (maximum 12 g/day) 3
Important Clinical Caveats
- Cefeperazone achieves exceptionally high biliary concentrations (675-6000 mcg/mL), making it particularly useful for biliary tract infections 4
- Urine levels exceed 32 mcg/mL for at least 12 hours, providing adequate coverage for urinary tract infections 4
- The drug is not significantly metabolized, reducing drug-drug interaction concerns 5
- Combination with sulbactam: When cefoperazone is combined with sulbactam (2 g/1 g formulation), the sulbactam component requires dose adjustment in renal failure, but cefoperazone dosing remains unchanged 6