What is the recommended dose of cefepime (Cefepime) for treating urinary tract infections (UTIs)?

Cefepime Dosing for Urinary Tract Infections

For uncomplicated or complicated UTIs, administer cefepime 0.5-1 g IV every 12 hours for mild to moderate infections, or 2 g IV every 12 hours for severe infections, with treatment duration of 7-10 days. 1, 2

Dosing by UTI Severity

Mild to Moderate UTI (Uncomplicated or Complicated)

• Dose: 0.5-1 g IV every 12 hours 1, 2
• Duration: 7-10 days 1, 2
• This lower dose range is appropriate for most community-acquired UTIs without systemic complications 2

Severe UTI (Uncomplicated or Complicated)

• Dose: 2 g IV every 12 hours 1, 2
• Duration: 10 days 1, 2
• This higher dose is indicated for severe infections, suspected pyelonephritis, or when Pseudomonas aeruginosa is a concern 1

Pyelonephritis (Hospitalized Patients)

• Dose: 1-2 g IV every 12 hours (twice daily) 1
• The European Association of Urology guidelines note that while lower doses (1 g) have been studied, the higher dose of 2 g is recommended for optimal outcomes 1
• Duration: Typically 10-14 days, with 14 days recommended for men when prostatitis cannot be excluded 1

Important Clinical Considerations

Renal Dose Adjustment

• Critical: Adjust dosing in patients with creatinine clearance ≤60 mL/min to prevent neurotoxicity 2
• The standard dosing recommendations above apply only to patients with CrCL >60 mL/min 2
• Failure to adjust doses in renal impairment can lead to serious neurotoxicity, particularly in geriatric patients 2

Administration Details

• Infusion time: Administer intravenously over approximately 30 minutes 2
• For severe infections or P. aeruginosa, consider extended infusion times (>3 hours) to optimize pharmacodynamic targets, though this is not standard practice 1

Treatment Duration Nuances

• Shorter duration (7 days): May be considered when the patient is hemodynamically stable and afebrile for at least 48 hours 1, 3
• Longer duration (14 days): Required for men when prostatitis cannot be excluded, or for complicated infections with delayed source control 1

Context Within UTI Management Algorithm

When to Use Cefepime

• Cefepime is an extended-spectrum cephalosporin appropriate for hospitalized patients with uncomplicated pyelonephritis requiring parenteral therapy 1
• It is also suitable for complicated UTIs when local resistance patterns support its use 1
• Reserve carbapenems and novel broad-spectrum agents for patients with early culture results indicating multidrug-resistant organisms 1

Empiric vs. Targeted Therapy

• Cefepime can be initiated empirically based on local resistance patterns 1
• Always obtain urine culture before starting antibiotics and adjust therapy based on susceptibility results 1, 3
• The choice should be optimized according to local resistance patterns 1

Step-Down to Oral Therapy

• Once the patient is hemodynamically stable and afebrile for 24-48 hours, consider switching to oral agents such as fluoroquinolones (if local resistance <10%), trimethoprim-sulfamethoxazole, or oral cephalosporins 1, 3

Common Pitfalls to Avoid

Dosing Errors

• Do not use the lower dose (1 g) for severe infections or suspected Pseudomonas—use 2 g every 12 hours or consider 2 g every 8 hours for P. aeruginosa 1
• Do not forget renal dose adjustment—unadjusted doses in renal impairment can cause seizures and encephalopathy 2

Inappropriate Use

• Do not use cefepime for simple cystitis—oral agents are preferred for uncomplicated lower UTI 1
• Do not use as monotherapy for febrile neutropenia at UTI doses—febrile neutropenia requires 2 g every 8 hours 2

Resistance Considerations

• Cefepime has enhanced activity against organisms producing inducible beta-lactamases compared to third-generation cephalosporins 4
• However, it is not active against ESBL-producing organisms or carbapenem-resistant Enterobacteriaceae—use alternative agents for these pathogens 1

Supporting Evidence Quality

The dosing recommendations are based on high-quality guideline evidence from the 2024 European Association of Urology guidelines 1 and FDA-approved labeling 2. Clinical trial data demonstrate that cefepime 500 mg every 12 hours achieves 89% clinical cure rates for complicated UTI and 92% for uncomplicated UTI 5, while 1 g twice daily achieves 94% cure rates across various infections including UTI with bacteremia 6. The newer combination cefepime/enmetazobactam shows superior efficacy to piperacillin/tazobactam (79.1% vs 58.9% treatment success), though this combination is not yet widely available 7.