Cefepime Dosage

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Usual Adult Dose for Bacteremia

2 g IV every 8 hours

Usual Adult Dose for Febrile Neutropenia

2 g IV every 8 hours for 7 days or until neutropenia resolves

The patient's clinical status should be reassessed after 3 to 5 days of antimicrobial therapy.

Usual Adult Dose for Intraabdominal Infection

Complicated (used with metronidazole): 2 g IV every 12 hours for 7 to 10 days

Usual Adult Dose for Nosocomial Pneumonia

1 to 2 g IV every 8 to 12 hours

Initial empiric treatment with broad-spectrum coverage according to the hospital's and/or ICU's antibiogram is recommended if multidrug-resistant organisms are suspected.

Duration: If the causative organism is not Pseudomonas aeruginosa, the duration of treatment should be as short as clinically possible (e.g., as little as 7 days) to reduce the risk of superinfections with resistant organisms.

Usual Adult Dose for Pneumonia

1 to 2 g IV every 12 hours for 10 days

Usual Adult Dose for Pyelonephritis

2 g IV every 12 hours for 10 days

Usual Adult Dose for Skin or Soft Tissue Infection

2 g IV every 12 hours for 10 days

Usual Adult Dose for Urinary Tract Infection

Mild to moderate; complicated or uncomplicated: 0.5 to 1 g IV or IM every 12 hours for 7 to 10 days

IM administration is considered to be a more appropriate route for mild to moderate, uncomplicated or complicated urinary tract infections due to E coli.

Severe; complicated or uncomplicated: 2 g IV every 12 hours for 10 days

Usual Pediatric Dose for Febrile Neutropenia

2 months up to 16 years and up to 40 kg: 50 mg/kg IV every 8 hours for 7 to 10 days depending on the nature and severity of the infection

The maximum pediatric dose should not exceed the recommended dose for adults.

Usual Pediatric Dose for Intraabdominal Infection

2 months up to 16 years and up to 40 kg: 50 mg/kg IV every 12 hours for 7 to 10 days depending on the nature and severity of the infection

The maximum pediatric dose should not exceed the recommended dose for adults.

Usual Pediatric Dose for Pneumonia

2 months up to 16 years and up to 40 kg: 50 mg/kg IV every 12 hours for 7 to 10 days depending on the nature and severity of the infection

The maximum pediatric dose should not exceed the recommended dose for adults.

Usual Pediatric Dose for Pyelonephritis

2 months up to 16 years and up to 40 kg: 50 mg/kg IV every 12 hours for 7 to 10 days depending on the nature and severity of the infection

The maximum pediatric dose should not exceed the recommended dose for adults.

Usual Pediatric Dose for Skin and Structure Infection

2 months up to 16 years and up to 40 kg: 50 mg/kg IV every 12 hours for 7 to 10 days depending on the nature and severity of the infection

The maximum pediatric dose should not exceed the recommended dose for adults.

Usual Pediatric Dose for Urinary Tract Infection

2 months up to 16 years and up to 40 kg: 50 mg/kg IV every 12 hours for 7 to 10 days depending on the nature and severity of the infection

IM administration is considered to be a more appropriate route for mild to moderate, uncomplicated or complicated urinary tract infections due to E coli.

The maximum pediatric dose should not exceed the recommended dose for adults.

Renal Dose Adjustments

Initial doses of cefepime in renally impaired patients (except hemodialysis patients) should be the same as in patients with normal renal function.

Maintenance Dosing
Mild infections:
CrCl 61 mL/min or more: 500 mg IV every 12 hours
CrCl 30 to 60 mL/min: 500 mg IV every 24 hours
CrCl 11 to 29 mL/min: 500 mg IV every 24 hours
CrCl 10 mL/min or less: 250 mg IV every 24 hours

Moderate infections:
CrCl 61 mL/min or more: 1 g IV every 12 hours
CrCl 30 to 60 mL/min: 1 g IV every 24 hours
CrCl 11 to 29 mL/min: 500 mg IV every 24 hours
CrCl 10 mL/min or less: 250 mg IV every 24 hours

Severe infections:
CrCl 61 mL/min or more: 2 g IV every 12 hours
CrCl 30 to 60 mL/min: 2 g IV every 24 hours
CrCl 11 to 29 mL/min: 1 g IV every 24 hours
CrCl 10 mL/min or less: 500 mg IV every 24 hours

Life threatening infections:
CrCl 61 mL/min or more: 2 g IV every 8 hours
CrCl 30 to 60 mL/min: 2 g IV every 12 hours
CrCl 11 to 29 mL/min: 2 g IV every 24 hours
CrCl 10 mL/min or less: 1 g IV every 24 hours

No data in pediatric patients with renal dysfunction are available; however, due to similar pharmacokinetics as adults, changes in the dosing schedule comparative to those in adults are recommended for pediatric patients.

Liver Dose Adjustments

No adjustment recommended.

Precautions

Serious and occasionally fatal hypersensitivity reactions have been reported with antibiotics. The drug should be discontinued immediately at the first appearance of a skin rash or other signs of hypersensitivity. Severe, acute hypersensitivity reactions may require treatment with epinephrine and other resuscitative measures including oxygen, intravenous fluids, antihistamines, corticosteroids, cardiovascular support and airway management as clinically indicated.

Neurological side effects have been reported with cefepime. Patients should inform their healthcare provider at once of any neurological signs and symptoms (including encephalopathy, myoclonus, seizures, and nonconvulsive status epilepticus) for immediate treatment, dosage adjustment, or discontinuation of cefepime.

Neurotoxicity and renal failure have been reported, mostly in renally impaired patients receiving higher than recommended doses of cefepime. The drug should be discontinued if seizures occur. Nephrotoxicity has occurred with concomitant cephalosporins and aminoglycosides or potent diuretics. Renal function should be monitored, especially in elderly patients.

Cephalosporins may be associated with a fall in prothrombin activity. Risk factors include renal or hepatic impairment, poor nutritional state, a protracted course of antimicrobial therapy, and chronic anticoagulation therapy. Prothrombin times should be monitored and vitamin K therapy initiated if indicated.

Clostridium difficile associated diarrhea (CDAD) has been reported with almost all antibiotics and may potentially be life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea following cephalosporin therapy. Mild cases generally improve with discontinuation of the drug, while severe cases may require supportive therapy and treatment with an antimicrobial agent effective against C difficile. Hypertoxin producing strains of C difficile cause increased morbidity and mortality; these infections can be resistant to antimicrobial treatment and may necessitate colectomy.

Safety and efficacy have not been established in pediatric patients less than 2 months of age. Safety and efficacy have not been established in pediatric patients with complicated intraabdominal infections.

Dialysis

Hemodialysis: 1 g IV on day 1, followed by 500 mg IV every 24 hours; 1 g IV every 24 hours is recommended for febrile neutropenia

On hemodialysis days, cefepime should be administered after the completion of hemodialysis. Doses should be administered at the same time each day when possible.

Different dose adjustments may be necessary in patients undergoing high-flux hemodialysis or continuous renal replacement therapy (CRRT). Doses should be based on the estimated cefepime clearance.

Continuous ambulatory peritoneal dialysis (CAPD):
Mild infections: 500 mg IV every 48 hours
Moderate infections: 1 g IV every 48 hours
Severe infections: 2 g IV every 48 hours
Life threatening infections: 2 g IV every 48 hours

In patients undergoing CAPD, cefepime should be administered at normal recommended doses at an interval of 48 hours.

Other Comments

Intravenous cefepime doses should be infused over 30 minutes.

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