Cefepime-Tazobactam Dosing Regimens
Standard Dosing for Normal Renal Function
For adults with normal renal function (CrCl >60 mL/min), administer cefepime-tazobactam 2g/2g (cefepime 2g + tazobactam 2g) intravenously every 8 hours as a 1.5-hour infusion. 1
- This dosing regimen achieves a combined probability of target attainment (PTA) of 99% for treating ESBL-producing pathogens with MICs up to 16 mg/L, including those resistant to both cefepime and piperacillin/tazobactam 1
- The 1.5-hour infusion duration is critical for optimizing pharmacokinetic/pharmacodynamic parameters and maximizing time above MIC 1
Dosing Adjustments for Renal Impairment
Mild Renal Impairment (CrCl 60-89 mL/min)
- Standard dose of 2g/2g every 8 hours over 1.5 hours 1
- Plasma exposure increases by approximately 1.2-1.3 fold compared to normal renal function 2
Moderate Renal Impairment (CrCl 30-59 mL/min)
- Reduce dose to 1g/1g (cefepime 1g + tazobactam 1g) every 8 hours over 1.5 hours 1
- Plasma exposure increases by approximately 2.3-fold for both components 2
Severe Renal Impairment (CrCl 15-29 mL/min)
- Reduce dose to 500mg/500mg every 8 hours over 1.5 hours 1
- Plasma exposure increases by approximately 4.0-4.7 fold 2
Very Severe Renal Impairment (CrCl 8-14 mL/min)
- Reduce dose to 500mg/500mg every 12 hours over 1.5 hours 1
End-Stage Renal Disease on Intermittent Hemodialysis
- Administer 500mg/500mg every 12 hours over 1.5 hours 1
- Plasma exposure increases by 8.5-fold for cefepime and 11.6-fold for tazobactam 2
- Administer doses after hemodialysis sessions when possible, as both components are significantly removed during dialysis 2
Special Population: Augmented Renal Clearance
Critically Ill Patients with High Renal Clearance (CrCl 120-180 mL/min)
- Administer standard dose of 2g/2g every 8 hours as a prolonged 4-hour infusion 1
- Extended infusion compensates for increased drug clearance in hypermetabolic states 1
- This population includes septic patients with fluid resuscitation and younger trauma patients 1
Clinical Considerations and Monitoring
Target Pathogen Coverage
- The recommended dosing regimens provide adequate coverage for ESBL-producing Enterobacteriaceae with cefepime-tazobactam MICs up to 16 mg/L 1
- This includes pathogens resistant to piperacillin/tazobactam, which is the primary indication for this combination 1
Safety Profile
- Single-dose studies demonstrated that cefepime-tazobactam was safe and well-tolerated across all degrees of renal function, including end-stage renal disease 2
- No adverse events were reported in the renal impairment pharmacokinetic study 2
Practical Implementation
- Common pitfall: Using fractions of vials for dose adjustments can lead to dosing errors and increased costs 3
- The recommended regimens use full-dose vials with adjusted intervals, which simplifies preparation and reduces medication errors 1
- Renal function should be assessed using the Cockcroft-Gault equation for creatinine clearance estimation to determine appropriate dosing 2