What is the dosage and treatment duration of Maxipime (Cefepime) for bacterial infections?

Maxipime (Cefepime) Dosing and Treatment Duration for Bacterial Infections

For most serious bacterial infections in adults, administer cefepime 1-2 g IV every 8-12 hours, with treatment duration of 7-10 days depending on infection site and severity. 1

Standard Adult Dosing by Infection Type

Pneumonia

• Moderate to severe pneumonia: 1-2 g IV every 8-12 hours for 10 days 1
• For Pseudomonas aeruginosa pneumonia specifically: 2 g IV every 8 hours 1
• Cefepime demonstrates comparable efficacy to ceftazidime and ceftriaxone when administered twice daily 2, 3

Urinary Tract Infections

• Mild to moderate UTI/pyelonephritis: 0.5-1 g IV every 12 hours for 7-10 days 1
• Severe UTI/pyelonephritis: 2 g IV every 12 hours for 10 days 1
• Lower doses (1 g twice daily) achieve 94% clinical cure rates for acute bacterial UTI 4

Skin and Soft Tissue Infections

• Uncomplicated infections: 2 g IV every 12 hours for 10 days 1
• Targets methicillin-susceptible Staphylococcus aureus and Streptococcus pyogenes 1

Complicated Intra-abdominal Infections

• 2 g IV every 8-12 hours for 7-10 days 1
• Must combine with metronidazole for anaerobic coverage 1
• Provides coverage against E. coli, viridans streptococci, P. aeruginosa, Klebsiella, Enterobacter, and Bacteroides fragilis 1

Febrile Neutropenia

• 2 g IV every 8 hours for 7 days or until neutropenia resolves 1
• Monotherapy may be insufficient in high-risk patients (recent bone marrow transplant, hypotension, severe/prolonged neutropenia, underlying hematologic malignancy) 1
• Comparable efficacy to ceftazidime when both given three times daily 5

Pediatric Dosing (2 months to 16 years)

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

Renal Dose Adjustments

Critical consideration: Patients with creatinine clearance ≤60 mL/min require dose reduction to compensate for slower renal elimination 1. The initial dose remains the same, but maintenance dosing must be adjusted based on creatinine clearance 1.

Administration Details

• Infusion time: Administer IV over approximately 30 minutes 1
• Twice-daily dosing advantage: Cefepime's pharmacokinetics support every 12-hour dosing for most indications, unlike ceftazidime which typically requires three-times-daily administration 3, 6
• Linear pharmacokinetics with elimination half-life of approximately 2 hours 3

Key Clinical Advantages

Resistance Profile

• Stable against common beta-lactamases: Cefepime resists hydrolysis by many plasmid- and chromosomally-mediated beta-lactamases 2, 3
• Poor inducer of AmpC beta-lactamases: Retains activity against Enterobacter species and other Enterobacteriaceae resistant to third-generation cephalosporins 2, 5
• Low cross-resistance: Maintains activity against organisms resistant to ceftazidime and other third-generation cephalosporins 5

Spectrum Coverage

• Gram-positive activity: Similar to cefotaxime/ceftriaxone against S. aureus and penicillin-resistant S. pneumoniae 2
• Gram-negative activity: Comparable to ceftazidime against P. aeruginosa and Enterobacteriaceae 2
• Enhanced activity: Superior to third-generation cephalosporins against derepressed mutants of Enterobacter spp. 2

Common Pitfalls to Avoid

• Do not use for methicillin-resistant S. aureus: Only effective against methicillin-susceptible isolates 1
• Inadequate monotherapy in high-risk neutropenia: Consider combination therapy for patients with severe risk factors 1
• Forgetting anaerobic coverage: Always add metronidazole for intra-abdominal infections 1
• Ignoring renal function: Failure to adjust dosing in renal impairment increases toxicity risk 1

Tolerability

Cefepime demonstrates a favorable safety profile similar to other parenteral cephalosporins 3, 6. Most common adverse events include rash, diarrhea, headache, nausea, and pruritus 2, 6. Only 2-3% of patients require treatment discontinuation due to adverse events 3, 6, 4.