Cefepime IV Dosing Interval
For adults with normal renal function, administer cefepime 2 g intravenously every 8 to 12 hours, with every 8 hours preferred for severe infections or suspected Pseudomonas aeruginosa. 1, 2
Standard Adult Dosing Intervals
The FDA-approved dosing intervals for cefepime vary by infection severity and renal function 2:
- Every 8 hours: For severe infections including febrile neutropenia (2 g every 8 hours) 1, 2
- Every 12 hours: For moderate infections in patients with normal renal function (1-2 g every 12 hours) 1, 2
Infection-Specific Recommendations
For complicated intra-abdominal infections: The Infectious Diseases Society of America recommends 2 g every 8-12 hours 1, while the World Society of Emergency Surgery specifically recommends 2 g every 8 hours for critically ill patients 3
For severe pneumonia or Pseudomonas infections: Administer 2 g every 8 hours 3
For hospital-acquired pneumonia in critically ill patients: The American Thoracic Society recommends 1-2 g every 8 hours 3
Pediatric Dosing Intervals
For children ≥2 months with normal renal function: Administer 50 mg/kg every 8-12 hours (maximum 2 g per dose) 3, 4
The pharmacokinetic data support every 12-hour dosing for pediatric patients with infections caused by pathogens with MICs ≤8 mg/L 4
Renal Impairment Adjustments
Dosing intervals must be extended based on creatinine clearance 2:
- CrCl 30-60 mL/min: Every 24 hours (for standard 1-2 g doses) or every 12 hours (for 2 g doses in severe infection)
- CrCl 11-29 mL/min: Every 24 hours
- CrCl <11 mL/min: Every 24 hours (reduced dose)
- Hemodialysis: 1 g on day 1, then 500 mg every 24 hours (administer after dialysis) 2
Critical Considerations for Dosing Interval Selection
Extended infusions over 3-4 hours improve pharmacodynamic target attainment for severe infections, particularly with high-MIC organisms (MIC ≥4 mg/L), and should be considered instead of shortening the dosing interval 3, 5
Monitor for neurotoxicity risk: Patients with renal impairment receiving inadequately adjusted dosing intervals may accumulate cefepime (trough concentrations >20-30 mg/L), leading to confusion, myoclonus, or seizures 6, 7. This risk increases when dosing intervals are too short for the patient's renal function.
Therapeutic drug monitoring should be considered in critically ill patients with fluctuating renal function to optimize both efficacy and safety 3, 6
Administration Timing
Administer at consistent times each day 2. For hemodialysis patients, always give the dose following dialysis completion 2.