What is the recommended dilution of Cefepime (Cefepime) with Normal Saline (NS) for intravenous (IV) administration?

Cefepime IV Dilution with Normal Saline

Cefepime for IV administration should be reconstituted and then diluted in 50-100 mL of Normal Saline (or other compatible diluent) and infused over 30 minutes for standard dosing.

Standard Reconstitution and Dilution Protocol

Reconstitution

• Cefepime vials must first be reconstituted with an appropriate diluent (Sterile Water for Injection, 0.9% Sodium Chloride, or D5W) according to vial size 1, 2
• The reconstituted solution should then be further diluted for IV infusion 3

Dilution Volume

• Standard dilution: 50-100 mL of Normal Saline for intermittent IV infusion 1, 3
• The diluted solution should be administered over 30-60 minutes as an intermittent infusion 1, 2

Alternative Administration Methods

• Prolonged infusion: Can be administered over 3 hours or as continuous infusion for critically ill patients to optimize pharmacodynamic targets 1
• Extended infusion: May provide better outcomes in patients with resistant pathogens or severe infections by maintaining drug concentrations above the minimum inhibitory concentration for longer periods 1

Dosing Considerations

Standard Adult Dosing

• Typical doses range from 1-2 g IV every 8-12 hours depending on infection severity and renal function 2, 3
• For life-threatening infections: 1000-2000 mg IV every 8-24 hours based on creatinine clearance 3

Pediatric Dosing

• Neonates <36 weeks gestational age: 30 mg/kg/dose IV every 12 hours 4
• Neonates ≥36 weeks: 50 mg/kg/dose IV every 12 hours 4
• Children: 50 mg/kg/dose IV every 8 hours for Pseudomonas infections (maximum 2000 mg/dose) 4

Critical Pharmacokinetic Points

Drug Characteristics

• Elimination half-life: approximately 2-2.3 hours in patients with normal renal function 1, 3, 5
• Protein binding: 20% (relatively low) 1
• Renal excretion: 85% excreted unchanged in urine 1
• Volume of distribution: approximately 0.2 L/kg (18-22 L in adults) 1, 5

Infusion Rate Rationale

• The 30-60 minute infusion time allows for optimal pharmacodynamic target attainment of 70% time above MIC for clinical efficacy 1
• Rapid bolus administration is not recommended as it does not optimize time-dependent killing characteristics of beta-lactam antibiotics 1

Special Population Adjustments

Renal Impairment

• Dosing must be adjusted based on creatinine clearance as cefepime is primarily renally eliminated 3, 5
• Patients on continuous renal replacement therapy (CRRT) may require higher doses (2 g loading dose followed by 1.5-1.75 g every 8 hours) to achieve therapeutic targets 6

Critically Ill Patients

• Consider therapeutic drug monitoring due to high inter-individual variability in volume of distribution and clearance 1
• Extended or continuous infusions may be beneficial for optimizing pharmacodynamic targets 1

Common Pitfalls to Avoid

• Do not administer as rapid IV push: Always dilute and infuse over at least 30 minutes 1, 2
• Monitor for neurotoxicity: Particularly in patients with impaired renal function, as reports of neurotoxicity have increased with higher cefepime exposures 1
• Avoid mixing with alkaline solutions: Do not mix cefepime with sodium bicarbonate or other alkaline solutions in the IV line 7
• Ensure adequate renal dose adjustment: Failure to adjust for renal function can lead to drug accumulation and increased neurotoxicity risk 1, 3