Cefepime Can Be Administered Intramuscularly
Yes, cefepime is approved for intramuscular (IM) administration and represents a viable alternative when intravenous access is unavailable or delayed. 1
FDA-Approved Administration Routes
The FDA label explicitly approves cefepime for both intravenous and intramuscular administration. 1 The drug can be reconstituted specifically for IM use by adding 2.4 mL of diluent to a 1 g vial, yielding a concentration of 280 mg/mL, with 3.6 mL withdrawn for administration. 1
Clinical Applications and Emergency Use
IM cefepime serves as a critical option when vascular access is limited or unavailable in emergency situations, particularly for treating urinary tract infections, bacteremia, and infections without an identified focus. 2
The Surviving Sepsis Campaign guidelines specifically mention IM cefepime as an alternative route when timely establishment of vascular access is not possible, though they emphasize attempting vascular access first. 2
Pharmacokinetic Profile After IM Administration
IM administration results in bioavailability averaging 82% (range 61-124%) in pediatric patients, with slightly prolonged elimination half-life (1.8-1.9 hours) and mean residence time (2.3-3.2 hours) compared to IV administration due to absorption kinetics from the injection site. 3
Peak serum concentrations occur between 0.5-2 hours after IM injection, with pharmacokinetic profiles similar to IV administration, supporting therapeutic efficacy. 4, 3
Stability and Preparation for IM Use
The reconstituted IM solution remains stable for 24 hours at room temperature (20-25°C) or 7 days refrigerated (2-8°C) when prepared with appropriate diluents including: 1
- Sterile Water for Injection
- 0.9% Sodium Chloride Injection
- 5% Dextrose Injection
- Sterile Bacteriostatic Water with Parabens or Benzyl Alcohol
- 0.5% or 1% Lidocaine Hydrochloride (which can reduce injection site discomfort)
Tolerability and Safety
IM cefepime demonstrates excellent tolerability with minimal injection site discomfort when properly reconstituted, with studies showing "strongly agreeable" global acceptability ratings from subjects. 4
The same neurotoxicity precautions apply regardless of administration route—particularly in patients with renal impairment who require dose adjustment to avoid encephalopathy, seizures, and other serious neurological adverse events. 1
Practical Considerations
IM administration is particularly valuable in outpatient settings, home hospice care, or when IV access is technically difficult, providing flexibility without compromising therapeutic outcomes. 4
Dosing strategies remain consistent across routes: 50 mg/kg every 8-12 hours in pediatric patients ≥2 months of age (maximum 2 g per dose), with adjustments based on renal function and infection severity. 3