What is the recommended IV (intravenous) infusion rate for Cefipime (Cefepime)?

Cefepime IV Infusion Rate

Cefepime should be administered as a 30-minute intravenous infusion for standard dosing, though extended infusions of 3-4 hours or continuous infusions may be preferred for critically ill patients or severe infections with high-MIC pathogens. 1, 2

Standard Infusion Protocol

• Standard administration: Infuse over 30-60 minutes for routine dosing 2, 3
• First dose: Always administer the initial dose as a 30-minute infusion, regardless of subsequent infusion strategy 4
• This approach is appropriate for most patients with normal renal function and non-severe infections 3

Extended and Continuous Infusion Strategies

When to consider prolonged infusions:

• Critically ill patients: Extended infusions (3-4 hours) or continuous infusions improve pharmacokinetic/pharmacodynamic target attainment, particularly for sepsis or severe pneumonia 1, 2
• High-MIC organisms: For pathogens with MIC ≥4 mg/L, especially Pseudomonas aeruginosa, extended infusions optimize time above MIC 1
• Augmented renal clearance: Critically ill patients with normal or enhanced renal function benefit from continuous infusions to maintain therapeutic concentrations 5

Practical implementation:

• Extended infusion: Administer each dose over 3-4 hours after the initial 30-minute loading dose 1, 4
• Continuous infusion: Give loading dose as rapid bolus, then maintain continuous infusion for subsequent doses 1
• Studies demonstrate that 37-44% of ICU patients fail to achieve therapeutic targets with standard 30-minute infusions 1

Dosing Considerations by Clinical Scenario

Severe infections (normal renal function):

• Standard dose: 2 g IV every 8 hours 6, 1
• Infusion time: 30 minutes for standard approach, or 3-4 hours for extended infusion 1, 2
• For Pseudomonas infections with elevated MICs, doses exceeding 4 g daily may be required 1

Pediatric patients:

• Dose: 50 mg/kg every 8-12 hours (maximum 2 g per dose) 1
• Infusion time: 30 minutes for standard dosing 5
• Continuous infusion: 100 mg/kg/day as continuous infusion for critically ill children with normal/augmented renal clearance 5

Renal impairment:

• Peak concentrations are not affected by renal dysfunction, but elimination half-life increases proportionately 7
• Standard 30-minute infusion is appropriate, but total daily dose must be reduced based on creatinine clearance 7
• Hemodialysis significantly shortens elimination half-life from 13.5 hours to 2.3 hours during dialysis 7

Monitoring and Safety

Therapeutic drug monitoring should be considered for:

• Critically ill patients with fluctuating renal function 1
• Life-threatening infections or infections with resistant pathogens 2
• Patients receiving extended or continuous infusions 1

Neurotoxicity risk:

• Risk increases when trough concentrations exceed 8× MIC 1
• Monitor for confusion, encephalopathy, myoclonus, and seizures, especially in renal impairment 1, 2
• Close monitoring is mandatory given cefepime's narrow therapeutic window 5

Key Clinical Pitfalls

• Avoid underdosing in critical illness: Standard 30-minute infusions may be inadequate for ICU patients with preserved renal function due to increased clearance and volume of distribution 1
• Don't forget loading dose: When using extended or continuous infusions, always give the first dose as a standard 30-minute infusion to rapidly achieve therapeutic levels 4
• Practical feasibility: Extended infusion cefepime is feasible without significant practical complications, as demonstrated in randomized trials 4