What is the dosage and treatment duration of cefepime for bacterial infections?

Cefepime Dosing and Treatment Duration for Bacterial Infections

Standard Adult Dosing

For most moderate to severe bacterial infections in adults, cefepime should be administered at 1-2 g IV every 8-12 hours, with specific dosing determined by infection site and severity. 1

Infection-Specific Dosing Recommendations

Pneumonia:

• Moderate to severe pneumonia (including S. pneumoniae, P. aeruginosa, K. pneumoniae, Enterobacter species): 1-2 g IV every 8-12 hours for 10 days 1
• For Pseudomonas aeruginosa pneumonia specifically: Use 2 g IV every 8 hours 2, 1
• Hospital-acquired/ventilator-associated pneumonia: 2 g IV every 8 hours for 10-14 days 2

Urinary Tract Infections:

• Mild to moderate uncomplicated/complicated UTI (including pyelonephritis): 0.5-1 g IV every 12 hours for 7-10 days 1
• Severe uncomplicated/complicated UTI: 2 g IV every 12 hours for 10 days 1

Skin and Soft Tissue Infections:

• Moderate to severe uncomplicated infections: 2 g IV every 12 hours for 10 days 1

Intra-abdominal Infections:

• Complicated intra-abdominal infections (in combination with metronidazole): 2 g IV every 8-12 hours for 7-10 days 1

Febrile Neutropenia:

• Empiric therapy: 2 g IV every 8 hours for 7 days or until resolution of neutropenia 1
• For patients whose fever resolves but remain neutropenic beyond 7 days, reassess need for continued therapy frequently 1

Bloodstream Infections:

• 10-14 days duration recommended 2

Pediatric Dosing (2 months to 16 years)

Standard pediatric dosing is 50 mg/kg per dose, with frequency and duration matching adult recommendations based on infection type. 1

• Uncomplicated/complicated UTI, uncomplicated skin infections, and pneumonia: 50 mg/kg every 12 hours 1
• Moderate to severe pneumonia due to P. aeruginosa: 50 mg/kg every 8 hours 1
• Febrile neutropenia: 50 mg/kg every 8 hours 1
• Maximum dose should not exceed recommended adult dose 1

Special Populations

Patients with Neutropenia, Chronic Lung Disease, or Indwelling Catheters:

• Consider cefepime instead of ceftriaxone for enhanced Pseudomonas coverage 2

Renal Impairment:

• Creatinine clearance ≤60 mL/min: Dose adjustment required to compensate for slower renal elimination 1
• Initial dose should match that for normal renal function, followed by adjusted maintenance dosing 1

Administration Details

Administer cefepime intravenously over approximately 30 minutes. 1

For infections with high MIC pathogens, prolonged infusion (>3 hours) of beta-lactams is recommended to optimize pharmacodynamic exposure. 2

Multidrug-Resistant Organisms

Carbapenem-Resistant Pseudomonas aeruginosa (CRPA):

• If susceptible to cefepime: 2 g IV every 8-12 hours for 5-14 days (5-10 days for complicated UTI/intra-abdominal infection; 10-14 days for pneumonia/bloodstream infection) 2

Third-Generation Cephalosporin-Resistant Enterobacterales:

• Cefepime may retain activity against AmpC-producing organisms 2
• However, evidence for cefepime versus carbapenems shows inconsistent results, with some studies suggesting higher mortality with cefepime for ESBL infections or when MIC is in the susceptible dose-dependent range 2

Clinical Efficacy Evidence

Cefepime demonstrates equivalent efficacy to third-generation cephalosporins (ceftazidime, ceftriaxone, cefotaxime) for moderate to severe community-acquired and nosocomial pneumonia when administered twice daily. 3, 4, 5

Key advantages include:

• Stability against many plasmid- and chromosome-mediated beta-lactamases 3, 5
• Poor inducer of AmpC beta-lactamases, retaining activity against Enterobacteriaceae resistant to third-generation cephalosporins 3, 5
• Twice-daily dosing for most indications improves convenience 5, 6

Important Caveats

• Infectious disease consultation is highly recommended for infections caused by multidrug-resistant organisms 2
• Treatment duration should be based on infection site, source control, underlying comorbidities, and initial response to therapy 2
• For patients with previous antibiotic failure with penicillins or other cephalosporins, cefepime has demonstrated clinical response 3
• Cefepime is generally well-tolerated, with most adverse events being mild to moderate (rash, diarrhea most common) 3, 5