What is the recommended dose of cefepime (Cefepime) for pneumonia?

From the Guidelines

The recommended dose of cefepime for pneumonia is 1-2 g every 8-12 hours. This dosage is based on the guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia, as outlined in the American Journal of Respiratory and Critical Care Medicine 1.

Key Considerations

• The dosage of cefepime may need to be adjusted based on renal function, with reduced doses for patients with impaired renal function.
• Cefepime is a broad-spectrum antibiotic effective against many gram-positive and gram-negative bacteria, including Pseudomonas aeruginosa.
• Patients should be monitored for potential side effects, including allergic reactions, gastrointestinal disturbances, and the risk of C. difficile infection.

Clinical Context

• The selection of initial appropriate therapy is crucial in the management of hospitalized patients with serious infections, as delays in appropriate antibiotic treatment can be associated with greater mortality and hospital costs 1.
• Cefepime is typically reserved for more severe cases of pneumonia or when resistant organisms are suspected.
• It is essential to obtain appropriate cultures before starting cefepime, if possible, to guide antibiotic therapy and minimize the risk of inappropriate treatment.

From the FDA Drug Label

Moderate to Severe Pneumonia due to S. pneumoniae†, P. aeruginosa‡, K pneumoniae, or Enterobacter species 1 to 2 g IV Every 8 to 12 hours Pediatric Patients (2 months up to 16 years) The maximum dose for pediatric patients should not exceed the recommended adult dose. The usual recommended dosage in pediatric patients up to 40 kg in weight for uncomplicated and complicated urinary tract infections (including pyelonephritis), uncomplicated skin and skin structure infections, and pneumonia is 50 mg per kg per dose, administered every 12 hours

The dose of cefepime for pneumonia is 1 to 2 g IV every 8 to 12 hours for adults. For pediatric patients up to 40 kg in weight, the recommended dose is 50 mg per kg per dose, administered every 12 hours 2.

From the Research

Dose of Cefepime for Pneumonia

• The dose of cefepime for pneumonia can vary depending on the severity of the infection and the patient's renal function.
• According to a study published in 2003 3, monotherapy with cefepime 1 or 2g, usually administered intravenously twice daily, was as effective for clinical and bacteriological response as ceftazidime, ceftriaxone or cefotaxime monotherapy in hospitalized adult patients with moderate to severe community-acquired or nosocomial pneumonia.
• Another study published in 2020 4 found that cystatin C-guided renal dose adjustment of cefepime treatment in hospitalized patients with pneumonia decreased the risk of acute kidney injury and cefepime-induced encephalopathy compared with serum creatinine-guided dosing.
• A study published in 1998 5 compared the safety and efficacy of intravenous cefepime (2 g administered every 12 h) to those of intravenous ceftriaxone (1 g administered every 12 h) for the empiric treatment of hospitalized patients with community-acquired pneumonia, and found that favorable clinical outcomes were comparable among clinically evaluated patients in the cefepime and ceftriaxone treatment arms.
• A 2020 study 6 found that cefepime 1 g administered intravenously every 8 h was as effective and safe as meropenem 0.5 g administered intravenously every 8 h in patients with moderate-to-severe aspiration pneumonia.
• A study published in 2008 7 found that a fixed dose combination of cefepime and amikacin was more effective in the treatment of nosocomial pneumonia than cefepime alone, with clinical and bacteriological successful outcomes significantly higher in the combination treatment group.

Dosage Regimens

• Cefepime 1 or 2g administered intravenously twice daily 3
• Cefepime 2g administered intravenously three times daily 3
• Cefepime 1 g administered intravenously every 8 h 6
• Cefepime 2.0g administered intravenously twice daily 7
• Fixed dose combination of cefepime and amikacin 2.5g administered intravenously twice daily 7