Cefepime Dosing for Pediatric Patients
For pediatric patients ≥2 months of age with normal renal function, administer cefepime 50 mg/kg intravenously or intramuscularly every 8-12 hours (maximum 2 g per dose), with every 8-hour dosing reserved for febrile neutropenia or severe infections. 1
Standard Dosing by Age and Indication
Infants and Children (2 months to 16 years)
- Standard dose: 50 mg/kg per dose every 12 hours for most infections 1, 2
- Febrile neutropenia: 50 mg/kg per dose every 8 hours (maximum 2 g per dose) 1
- Maximum single dose: Do not exceed 2 g per dose regardless of weight 1
Route of Administration
- Intravenous: Administer over approximately 30 minutes 1
- Intramuscular: Acceptable alternative with 82% bioavailability (range 61-124%), though absorption results in slightly prolonged half-life (1.9 vs 1.8 hours) 2
Pharmacokinetic Rationale
The every 12-hour dosing interval is supported by robust pharmacokinetic data:
- Elimination half-life: Averages 1.7 hours in pediatric patients ≥2 months 2
- Renal clearance: 1.9 mL/min/kg with 57-89% recovered unchanged in urine 2
- Volume of distribution: 0.35 L/kg at steady state 2
- Pharmacokinetic modeling demonstrates that 50 mg/kg every 12 hours achieves adequate time above MIC (100% fT>MIC) for pathogens with MIC ≤8 mg/L 2
Special Considerations
Renal Impairment
Dose adjustment is mandatory for patients with creatinine clearance ≤60 mL/min to prevent neurotoxicity 1. Recent evidence suggests:
- Normal/augmented renal clearance: Consider continuous infusion (100 mg/kg/day) for critically ill children to optimize PK/PD targets 3
- Renal failure: 100 mg/kg/day divided every 12 hours over 30 minutes is adequate 3
Age-Specific Nuances
- Infants <6 months: May have slightly prolonged half-life and mean residence time, but no dose adjustment is required for those ≥2 months 2
- Neonates <2 months: Cefepime is not the preferred agent; guidelines recommend ceftazidime (150 mg/kg/day divided every 8 hours) or cefotaxime instead 4
Clinical Context from Guidelines
While the FDA label provides cefepime dosing, pediatric infectious disease guidelines preferentially recommend ceftriaxone or ceftazidime for most serious infections in young infants:
- For febrile infants 8-60 days: Ceftriaxone 50-100 mg/kg/day is preferred over cefepime 4
- For community-acquired pneumonia: Ceftriaxone or cefotaxime are first-line; cefepime is not specifically mentioned 4
Important Caveats
- Neurotoxicity risk: Particularly in patients with renal impairment receiving unadjusted doses; discontinue if neurotoxicity occurs 1
- Therapeutic drug monitoring: Mandatory in critically ill children given cefepime's narrow therapeutic window 3
- Galaxy Container limitation: Should only be used in pediatric patients requiring the entire 1 or 2 gram dose, not fractions thereof 1
- Cross-hypersensitivity: May occur in up to 10% of patients with penicillin allergy 1