Cefepime Dosage
Medically reviewed by Drugs.com. Last updated on Aug 14, 2023.
Applies to the following strengths: 500 mg; 1 g; 2 g; 1 g/50 mL-iso-osmotic dextrose; 2 g/100 mL
Usual Adult Dose for:
- Bacteremia
- Febrile Neutropenia
- Intraabdominal Infection
- Pneumonia
- Nosocomial Pneumonia
- Skin and Structure Infection
- Pyelonephritis
- Urinary Tract Infection
- Meningitis
- Meningitis - Meningococcal
- Meningitis - Haemophilus influenzae
- Meningitis - Pneumococcal
- Meningitis - Listeriosis
- Meningitis - Streptococcus Group B
- Joint Infection
- Osteomyelitis
- Endocarditis
- Peritonitis
Usual Pediatric Dose for:
- Bacteremia
- Febrile Neutropenia
- Bacterial Infection
- Intraabdominal Infection
- Pneumonia
- Pyelonephritis
- Urinary Tract Infection
- Skin and Structure Infection
- Meningitis
- Meningitis - Meningococcal
- Meningitis - Haemophilus influenzae
- Meningitis - Pneumococcal
- Meningitis - Listeriosis
- Meningitis - Streptococcus Group B
- Peritonitis
- Endocarditis
Additional dosage information:
Usual Adult Dose for Bacteremia
Pneumonia associated with bacteremia: 1 to 2 grams via IV injection over 30 minutes every 8 to 12 hours
Mild to moderate urinary tract infections (UTIs) associated with bacteremia: 0.5 to 1 gram via IV injection over 30 minutes every 12 hours
Severe UTIs associated with bacteremia: 2 grams via IV injection over 30 minutes every 12 hours
Duration of therapy:
- Pneumonia: 10 days
- Mild to moderate UTIs: 7 to 10 days
- Severe UTIs: 10 days
Uses:
- Treatment of moderate to severe pneumonia and concurrent bacteremia caused by susceptible strains of Streptococcus pneumoniae, Pseudomonas aeruginosa, Klebsiella pneumoniae, or Enterobacter species
- Treatment of complicated and uncomplicated mild to moderate urinary tract infections and concurrent bacteremia caused by susceptible isolates of Escherichia coli, K pneumoniae, or Proteus mirabilis
- Treatment of complicated and uncomplicated severe urinary tract infections and concurrent bacteremia caused by susceptible isolates of E coli or K pneumoniae
Infectious Diseases Society of America (IDSA) Recommendations:
2 grams IV every 8 hours with/without aminoglycoside
Comment: Preferred treatments may be given with or without aminoglycosides.
Uses:
- Adjunctive preferred treatment of IV catheter-related bloodstream infections caused by P aeruginosa
- Alternative treatment of IV catheter-related bloodstream infections caused by Enterobacter species and Serratia marcescens
Usual Adult Dose for Febrile Neutropenia
Empiric treatment: 2 grams via IV injection over 30 minutes every 8 hours
- Duration of therapy: 7 days OR until resolution of neutropenia
Comments:
- The continued need for antibiotic treatment should be frequently reassessed in patients whose fever resolves but remain neutropenic for longer than 7 days.
- Use may be inappropriate in patients at high risk for severe infection (e.g., patients with a history of recent bone marrow transplantation, hypotension at presentation, underlying hematologic malignancy, with severe/prolonged neutropenia).
Use: Monotherapy for empiric treatment of febrile neutropenia
Usual Adult Dose for Intraabdominal Infection
Complicated intraabdominal infections: 2 grams via IV injection over 30 minutes every 8 to 12 hours
Intraabdominal infections caused by Pseudomonas: 2 grams via IV injection over 30 minutes every 8 hours
Duration of therapy: 7 to 10 days
Use: In combination with metronidazole for the treatment of complicated intraabdominal infections caused by susceptible isolates of Bacteroides fragilis, Enterobacter species, E coli, K pneumoniae, P aeruginosa, or viridans group streptococci (VGS)
Surgical Infection Society (SIS) and IDSA Recommendations:
Initial dose: 2 grams IV every 8 to 12 hours PLUS metronidazole
Comment: Maintenance doses should be based on adjusted body weight and serum drug concentrations.
Uses:
- Empiric combination treatment of complicated extra-biliary community-acquired intraabdominal infections in patients with severe physiologic disturbance, advanced age, or immunocompromised stage caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae or P aeruginosa, or gram-negative bacilli (GNB) less than 20% resistant to this drug
- Adjunctive empiric treatment of community-acquired acute cholecystitis of severe physiologic disturbance, advanced age, and/or immunocompromised state
- Adjunctive empiric treatment of acute cholangitis following bilio-enteric anastomosis of any severity
- Adjunctive empiric treatment of healthcare-associated biliary infection of any severity
Usual Adult Dose for Pneumonia
Moderate to severe pneumonia: 1 to 2 grams via IV injection over 30 minutes every 8 to 12 hours
Pneumonia caused by P aeruginosa: 2 grams via IV injection over 30 minutes every 8 hours
Duration of therapy: 10 days
Use: Treatment of moderate to severe pneumonia caused by susceptible strains of Enterobacter species, K pneumoniae, P aeruginosa, or S pneumoniae
IDSA and American Thoracic Society (ATS) Recommendations:
2 grams IV every 8 hours
Uses:
- Initial empiric treatment for hospital-acquired pneumonia (non-ventilator-associated pneumonia) in patients not at high risk of mortality and with no factors increasing the likelihood of methicillin-resistant Staphylococcus aureus (MRSA)
- Initial empiric treatment for hospital-acquired pneumonia (non-ventilator-associated pneumonia) in patients not at high-risk of mortality, but with factors increasing the likelihood of MRSA (e.g., previous IV antibiotic treatment within 90 days, treatment in a unit where the prevalence of MRSA among S aureus isolates is unknown OR greater than 20%)
- Initial empiric treatment for hospital-acquired pneumonia (non-ventilator-associated pneumonia) in patients at high-risk of mortality or receipt of IV antibiotics during the prior 90 days
- Adjunctive empiric treatment for suspected ventilator-associated pneumonia in units where empiric MRSA coverage and double antipseudomonal/gram-negative coverage are appropriate
Usual Adult Dose for Nosocomial Pneumonia
Moderate to severe pneumonia: 1 to 2 grams via IV injection over 30 minutes every 8 to 12 hours
Pneumonia caused by P aeruginosa: 2 grams via IV injection over 30 minutes every 8 hours
Duration of therapy: 10 days
Use: Treatment of moderate to severe pneumonia caused by susceptible strains of Enterobacter species, K pneumoniae, P aeruginosa, or S pneumoniae
IDSA and American Thoracic Society (ATS) Recommendations:
2 grams IV every 8 hours
Uses:
- Initial empiric treatment for hospital-acquired pneumonia (non-ventilator-associated pneumonia) in patients not at high risk of mortality and with no factors increasing the likelihood of methicillin-resistant Staphylococcus aureus (MRSA)
- Initial empiric treatment for hospital-acquired pneumonia (non-ventilator-associated pneumonia) in patients not at high-risk of mortality, but with factors increasing the likelihood of MRSA (e.g., previous IV antibiotic treatment within 90 days, treatment in a unit where the prevalence of MRSA among S aureus isolates is unknown OR greater than 20%)
- Initial empiric treatment for hospital-acquired pneumonia (non-ventilator-associated pneumonia) in patients at high-risk of mortality or receipt of IV antibiotics during the prior 90 days
- Adjunctive empiric treatment for suspected ventilator-associated pneumonia in units where empiric MRSA coverage and double antipseudomonal/gram-negative coverage are appropriate
Usual Adult Dose for Skin and Structure Infection
2 grams via IV injection over 30 minutes every 12 hours
- Duration of therapy: 10 days
Uses:
- Treatment of uncomplicated skin and skin structure infections caused by S aureus (only methicillin-susceptible isolates) or Streptococcus pyogenes
- Treatment of moderate to severe uncomplicated skin and skin structure infections caused by MSSA or S pyogenes
Usual Adult Dose for Pyelonephritis
Mild to moderate uncomplicated OR complicated infections: 0.5 to 1 gram IM OR via IV injection over 30 minutes every 12 hours
Severe uncomplicated OR complicated infections: 2 grams via IV injection over 30 minutes every 12 hours
Duration of therapy:
- Mild to moderate: 7 to 10 days
- Severe: 10 days
Comment: Mild to moderate uncomplicated and complicated infections caused by E coli may be treated via IM administration; other isolates should be treated via IV administration.
Uses:
- Treatment of complicated and uncomplicated mild to moderate UTIs caused by susceptible isolates of E coli, K pneumoniae, or P mirabilis
- Treatment of complicated and uncomplicated severe urinary tract infections caused by susceptible isolates of E coli or K pneumoniae
- Treatment of pyelonephritis
Usual Adult Dose for Urinary Tract Infection
Mild to moderate uncomplicated OR complicated infections: 0.5 to 1 gram IM OR via IV injection over 30 minutes every 12 hours
Severe uncomplicated OR complicated infections: 2 grams via IV injection over 30 minutes every 12 hours
Duration of therapy:
- Mild to moderate: 7 to 10 days
- Severe: 10 days
Comment: Mild to moderate uncomplicated and complicated infections caused by E coli may be treated via IM administration; other isolates should be treated via IV administration.
Uses:
- Treatment of complicated and uncomplicated mild to moderate UTIs caused by susceptible isolates of E coli, K pneumoniae, or P mirabilis
- Treatment of complicated and uncomplicated severe urinary tract infections caused by susceptible isolates of E coli or K pneumoniae
- Treatment of pyelonephritis
Usual Adult Dose for Meningitis
IDSA, American Academy of Neurology (AAN), American Association of Neurological Surgeons (AANS), and Neurocritical Care Society (NCS) Recommendations:
2 grams IV every 8 hours
- Maximum dose: 8 grams/day
Duration of therapy:
- Neisseria meningitis or Haemophilus influenzae: 7 days
- Coagulase-negative staphylococcus or Propionibacterium acnes with no/minimal cerebrospinal fluid (CSF) pleocytosis, normal CSF glucose, few symptoms/systemic features: 10 days
- Coagulase-negative staphylococcus or P acnes with significant CSF pleocytosis, S aureus or GNB with/without significant CSF pleocytosis, CSF hypoglycorrhachia, or symptoms/systemic features: 10 to 14 days
- S pneumoniae: 10 to 14 days
- Streptococcus agalactiae: 14 to 21 days
- Aerobic GNB: 21 days
- Listeria monocytogenes: At least 21 days
- Repeatedly positive CSF cultures on appropriate antimicrobial treatment: Continue treatment for 10 to 14 days after the last positive culture
Uses:
- Standard treatment of healthcare-associated ventriculitis and meningitis caused by P aeruginosa
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by S pneumoniae with a penicillin minimum inhibitory concentration (MIC) at least 0.12 mcg/mL AND a cefotaxime/ceftriaxone MIC less than 1 mcg/mL
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by beta-lactamase negative H influenzae
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by ESBL GNB
- Alternative empiric treatment for meningitis caused by H influenzae or E coli
- Adjunctive empiric treatment of patients with penetrating head trauma and purulent meningitis caused by S aureus, coagulase-negative staphylococci (especially Staphylococcus epidermidis), aerobic GNB (e.g., P aeruginosa)
- Adjunctive empiric treatment of postneurosurgery patients with purulent meningitis caused by aerobic GNB (e.g., P aeruginosa), S aureus, and/or coagulase-negative staphylococci, especially S epidermidis
- Adjunctive empiric treatment of patients with CSF shunt and purulent meningitis caused by coagulase-negative staphylococci (especially S epidermidis), S aureus, aerobic GNB (e.g., P aeruginosa), and/or P acnes
- Alternative treatment of bacterial meningitis caused by S pneumoniae with a penicillin MIC between 0.1 to 1 mcg/mL
- Standard treatment of bacterial meningitis caused by P aeruginosa
- Alternative treatment of bacterial meningitis caused by beta-lactamase negative OR beta-lactamase positive H influenzae
Usual Adult Dose for Meningitis - Meningococcal
IDSA, American Academy of Neurology (AAN), American Association of Neurological Surgeons (AANS), and Neurocritical Care Society (NCS) Recommendations:
2 grams IV every 8 hours
- Maximum dose: 8 grams/day
Duration of therapy:
- Neisseria meningitis or Haemophilus influenzae: 7 days
- Coagulase-negative staphylococcus or Propionibacterium acnes with no/minimal cerebrospinal fluid (CSF) pleocytosis, normal CSF glucose, few symptoms/systemic features: 10 days
- Coagulase-negative staphylococcus or P acnes with significant CSF pleocytosis, S aureus or GNB with/without significant CSF pleocytosis, CSF hypoglycorrhachia, or symptoms/systemic features: 10 to 14 days
- S pneumoniae: 10 to 14 days
- Streptococcus agalactiae: 14 to 21 days
- Aerobic GNB: 21 days
- Listeria monocytogenes: At least 21 days
- Repeatedly positive CSF cultures on appropriate antimicrobial treatment: Continue treatment for 10 to 14 days after the last positive culture
Uses:
- Standard treatment of healthcare-associated ventriculitis and meningitis caused by P aeruginosa
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by S pneumoniae with a penicillin minimum inhibitory concentration (MIC) at least 0.12 mcg/mL AND a cefotaxime/ceftriaxone MIC less than 1 mcg/mL
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by beta-lactamase negative H influenzae
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by ESBL GNB
- Alternative empiric treatment for meningitis caused by H influenzae or E coli
- Adjunctive empiric treatment of patients with penetrating head trauma and purulent meningitis caused by S aureus, coagulase-negative staphylococci (especially Staphylococcus epidermidis), aerobic GNB (e.g., P aeruginosa)
- Adjunctive empiric treatment of postneurosurgery patients with purulent meningitis caused by aerobic GNB (e.g., P aeruginosa), S aureus, and/or coagulase-negative staphylococci, especially S epidermidis
- Adjunctive empiric treatment of patients with CSF shunt and purulent meningitis caused by coagulase-negative staphylococci (especially S epidermidis), S aureus, aerobic GNB (e.g., P aeruginosa), and/or P acnes
- Alternative treatment of bacterial meningitis caused by S pneumoniae with a penicillin MIC between 0.1 to 1 mcg/mL
- Standard treatment of bacterial meningitis caused by P aeruginosa
- Alternative treatment of bacterial meningitis caused by beta-lactamase negative OR beta-lactamase positive H influenzae
Usual Adult Dose for Meningitis - Haemophilus influenzae
IDSA, American Academy of Neurology (AAN), American Association of Neurological Surgeons (AANS), and Neurocritical Care Society (NCS) Recommendations:
2 grams IV every 8 hours
- Maximum dose: 8 grams/day
Duration of therapy:
- Neisseria meningitis or Haemophilus influenzae: 7 days
- Coagulase-negative staphylococcus or Propionibacterium acnes with no/minimal cerebrospinal fluid (CSF) pleocytosis, normal CSF glucose, few symptoms/systemic features: 10 days
- Coagulase-negative staphylococcus or P acnes with significant CSF pleocytosis, S aureus or GNB with/without significant CSF pleocytosis, CSF hypoglycorrhachia, or symptoms/systemic features: 10 to 14 days
- S pneumoniae: 10 to 14 days
- Streptococcus agalactiae: 14 to 21 days
- Aerobic GNB: 21 days
- Listeria monocytogenes: At least 21 days
- Repeatedly positive CSF cultures on appropriate antimicrobial treatment: Continue treatment for 10 to 14 days after the last positive culture
Uses:
- Standard treatment of healthcare-associated ventriculitis and meningitis caused by P aeruginosa
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by S pneumoniae with a penicillin minimum inhibitory concentration (MIC) at least 0.12 mcg/mL AND a cefotaxime/ceftriaxone MIC less than 1 mcg/mL
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by beta-lactamase negative H influenzae
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by ESBL GNB
- Alternative empiric treatment for meningitis caused by H influenzae or E coli
- Adjunctive empiric treatment of patients with penetrating head trauma and purulent meningitis caused by S aureus, coagulase-negative staphylococci (especially Staphylococcus epidermidis), aerobic GNB (e.g., P aeruginosa)
- Adjunctive empiric treatment of postneurosurgery patients with purulent meningitis caused by aerobic GNB (e.g., P aeruginosa), S aureus, and/or coagulase-negative staphylococci, especially S epidermidis
- Adjunctive empiric treatment of patients with CSF shunt and purulent meningitis caused by coagulase-negative staphylococci (especially S epidermidis), S aureus, aerobic GNB (e.g., P aeruginosa), and/or P acnes
- Alternative treatment of bacterial meningitis caused by S pneumoniae with a penicillin MIC between 0.1 to 1 mcg/mL
- Standard treatment of bacterial meningitis caused by P aeruginosa
- Alternative treatment of bacterial meningitis caused by beta-lactamase negative OR beta-lactamase positive H influenzae
Usual Adult Dose for Meningitis - Pneumococcal
IDSA, American Academy of Neurology (AAN), American Association of Neurological Surgeons (AANS), and Neurocritical Care Society (NCS) Recommendations:
2 grams IV every 8 hours
- Maximum dose: 8 grams/day
Duration of therapy:
- Neisseria meningitis or Haemophilus influenzae: 7 days
- Coagulase-negative staphylococcus or Propionibacterium acnes with no/minimal cerebrospinal fluid (CSF) pleocytosis, normal CSF glucose, few symptoms/systemic features: 10 days
- Coagulase-negative staphylococcus or P acnes with significant CSF pleocytosis, S aureus or GNB with/without significant CSF pleocytosis, CSF hypoglycorrhachia, or symptoms/systemic features: 10 to 14 days
- S pneumoniae: 10 to 14 days
- Streptococcus agalactiae: 14 to 21 days
- Aerobic GNB: 21 days
- Listeria monocytogenes: At least 21 days
- Repeatedly positive CSF cultures on appropriate antimicrobial treatment: Continue treatment for 10 to 14 days after the last positive culture
Uses:
- Standard treatment of healthcare-associated ventriculitis and meningitis caused by P aeruginosa
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by S pneumoniae with a penicillin minimum inhibitory concentration (MIC) at least 0.12 mcg/mL AND a cefotaxime/ceftriaxone MIC less than 1 mcg/mL
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by beta-lactamase negative H influenzae
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by ESBL GNB
- Alternative empiric treatment for meningitis caused by H influenzae or E coli
- Adjunctive empiric treatment of patients with penetrating head trauma and purulent meningitis caused by S aureus, coagulase-negative staphylococci (especially Staphylococcus epidermidis), aerobic GNB (e.g., P aeruginosa)
- Adjunctive empiric treatment of postneurosurgery patients with purulent meningitis caused by aerobic GNB (e.g., P aeruginosa), S aureus, and/or coagulase-negative staphylococci, especially S epidermidis
- Adjunctive empiric treatment of patients with CSF shunt and purulent meningitis caused by coagulase-negative staphylococci (especially S epidermidis), S aureus, aerobic GNB (e.g., P aeruginosa), and/or P acnes
- Alternative treatment of bacterial meningitis caused by S pneumoniae with a penicillin MIC between 0.1 to 1 mcg/mL
- Standard treatment of bacterial meningitis caused by P aeruginosa
- Alternative treatment of bacterial meningitis caused by beta-lactamase negative OR beta-lactamase positive H influenzae
Usual Adult Dose for Meningitis - Listeriosis
IDSA, American Academy of Neurology (AAN), American Association of Neurological Surgeons (AANS), and Neurocritical Care Society (NCS) Recommendations:
2 grams IV every 8 hours
- Maximum dose: 8 grams/day
Duration of therapy:
- Neisseria meningitis or Haemophilus influenzae: 7 days
- Coagulase-negative staphylococcus or Propionibacterium acnes with no/minimal cerebrospinal fluid (CSF) pleocytosis, normal CSF glucose, few symptoms/systemic features: 10 days
- Coagulase-negative staphylococcus or P acnes with significant CSF pleocytosis, S aureus or GNB with/without significant CSF pleocytosis, CSF hypoglycorrhachia, or symptoms/systemic features: 10 to 14 days
- S pneumoniae: 10 to 14 days
- Streptococcus agalactiae: 14 to 21 days
- Aerobic GNB: 21 days
- Listeria monocytogenes: At least 21 days
- Repeatedly positive CSF cultures on appropriate antimicrobial treatment: Continue treatment for 10 to 14 days after the last positive culture
Uses:
- Standard treatment of healthcare-associated ventriculitis and meningitis caused by P aeruginosa
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by S pneumoniae with a penicillin minimum inhibitory concentration (MIC) at least 0.12 mcg/mL AND a cefotaxime/ceftriaxone MIC less than 1 mcg/mL
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by beta-lactamase negative H influenzae
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by ESBL GNB
- Alternative empiric treatment for meningitis caused by H influenzae or E coli
- Adjunctive empiric treatment of patients with penetrating head trauma and purulent meningitis caused by S aureus, coagulase-negative staphylococci (especially Staphylococcus epidermidis), aerobic GNB (e.g., P aeruginosa)
- Adjunctive empiric treatment of postneurosurgery patients with purulent meningitis caused by aerobic GNB (e.g., P aeruginosa), S aureus, and/or coagulase-negative staphylococci, especially S epidermidis
- Adjunctive empiric treatment of patients with CSF shunt and purulent meningitis caused by coagulase-negative staphylococci (especially S epidermidis), S aureus, aerobic GNB (e.g., P aeruginosa), and/or P acnes
- Alternative treatment of bacterial meningitis caused by S pneumoniae with a penicillin MIC between 0.1 to 1 mcg/mL
- Standard treatment of bacterial meningitis caused by P aeruginosa
- Alternative treatment of bacterial meningitis caused by beta-lactamase negative OR beta-lactamase positive H influenzae
Usual Adult Dose for Meningitis - Streptococcus Group B
IDSA, American Academy of Neurology (AAN), American Association of Neurological Surgeons (AANS), and Neurocritical Care Society (NCS) Recommendations:
2 grams IV every 8 hours
- Maximum dose: 8 grams/day
Duration of therapy:
- Neisseria meningitis or Haemophilus influenzae: 7 days
- Coagulase-negative staphylococcus or Propionibacterium acnes with no/minimal cerebrospinal fluid (CSF) pleocytosis, normal CSF glucose, few symptoms/systemic features: 10 days
- Coagulase-negative staphylococcus or P acnes with significant CSF pleocytosis, S aureus or GNB with/without significant CSF pleocytosis, CSF hypoglycorrhachia, or symptoms/systemic features: 10 to 14 days
- S pneumoniae: 10 to 14 days
- Streptococcus agalactiae: 14 to 21 days
- Aerobic GNB: 21 days
- Listeria monocytogenes: At least 21 days
- Repeatedly positive CSF cultures on appropriate antimicrobial treatment: Continue treatment for 10 to 14 days after the last positive culture
Uses:
- Standard treatment of healthcare-associated ventriculitis and meningitis caused by P aeruginosa
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by S pneumoniae with a penicillin minimum inhibitory concentration (MIC) at least 0.12 mcg/mL AND a cefotaxime/ceftriaxone MIC less than 1 mcg/mL
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by beta-lactamase negative H influenzae
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by ESBL GNB
- Alternative empiric treatment for meningitis caused by H influenzae or E coli
- Adjunctive empiric treatment of patients with penetrating head trauma and purulent meningitis caused by S aureus, coagulase-negative staphylococci (especially Staphylococcus epidermidis), aerobic GNB (e.g., P aeruginosa)
- Adjunctive empiric treatment of postneurosurgery patients with purulent meningitis caused by aerobic GNB (e.g., P aeruginosa), S aureus, and/or coagulase-negative staphylococci, especially S epidermidis
- Adjunctive empiric treatment of patients with CSF shunt and purulent meningitis caused by coagulase-negative staphylococci (especially S epidermidis), S aureus, aerobic GNB (e.g., P aeruginosa), and/or P acnes
- Alternative treatment of bacterial meningitis caused by S pneumoniae with a penicillin MIC between 0.1 to 1 mcg/mL
- Standard treatment of bacterial meningitis caused by P aeruginosa
- Alternative treatment of bacterial meningitis caused by beta-lactamase negative OR beta-lactamase positive H influenzae
Usual Adult Dose for Joint Infection
IDSA Recommendations:
P aeruginosa osteomyelitis: 2 grams IV every 8 to 12 hours
Enterobacteriaceae osteomyelitis and prosthetic joint infections: 2 grams IV every 12 hours
Duration of therapy:
- Severe, soft tissue-only diabetic foot infections: 2 to 4 weeks
- Residual infected, but viable, bone in diabetic foot infections: 4 to 6 weeks
- Osteomyelitis and prosthetic joint infections: 6 weeks
- No surgery or postoperative residual dead bone in diabetic foot infections: 3 months or longer
Comments:
- Patients with diabetic foot infections should be started on parenteral treatment and should be switched to oral formulations when possible.
- Obligate anaerobe coverage should be considered in patients with severe diabetic foot infections.
Uses:
- Preferred treatment of native vertebral osteomyelitis cause by Enterobacteriaceae species
- Preferred treatment of native vertebral osteomyelitis caused by P aeruginosa
- Preferred treatment of prosthetic joint infections caused by P aeruginosa
- Preferred treatment of prosthetic joint infections caused by Enterobacter species
- Adjunctive empiric treatment (with vancomycin) of moderate or severe diabetic foot infections caused by MRSA, Enterobacteriaceae, Pseudomonas, and/or obligate anaerobes
Usual Adult Dose for Osteomyelitis
IDSA Recommendations:
P aeruginosa osteomyelitis: 2 grams IV every 8 to 12 hours
Enterobacteriaceae osteomyelitis and prosthetic joint infections: 2 grams IV every 12 hours
Duration of therapy:
- Severe, soft tissue-only diabetic foot infections: 2 to 4 weeks
- Residual infected, but viable, bone in diabetic foot infections: 4 to 6 weeks
- Osteomyelitis and prosthetic joint infections: 6 weeks
- No surgery or postoperative residual dead bone in diabetic foot infections: 3 months or longer
Comments:
- Patients with diabetic foot infections should be started on parenteral treatment and should be switched to oral formulations when possible.
- Obligate anaerobe coverage should be considered in patients with severe diabetic foot infections.
Uses:
- Preferred treatment of native vertebral osteomyelitis cause by Enterobacteriaceae species
- Preferred treatment of native vertebral osteomyelitis caused by P aeruginosa
- Preferred treatment of prosthetic joint infections caused by P aeruginosa
- Preferred treatment of prosthetic joint infections caused by Enterobacter species
- Adjunctive empiric treatment (with vancomycin) of moderate or severe diabetic foot infections caused by MRSA, Enterobacteriaceae, Pseudomonas, and/or obligate anaerobes
Usual Adult Dose for Endocarditis
American Heart Association (AHA) and IDSA Recommendations:
Early, culture-negative endocarditis: 2 grams IV 3 times per day PLUS vancomycin, gentamicin, AND rifampin
- Maximum dose: 6 grams/day
- Duration of therapy: At least 6 weeks
Comment: Gentamicin should be added to patients with enterococcal infections.
Uses:
- Empiric alternative treatment (with gentamicin) of community-acquired native valve or late prosthetic valve (over 1 year after surgery) endocarditis
- Empiric treatment of nosocomial endocarditis associated with vascular cannula or early prosthetic valve endocarditis (1 year or less after surgery)
- Adjunctive empiric treatment of nosocomial endocarditis associated with enteric GNB
- Empiric treatment in early, culture-negative, prosthetic valve endocarditis
Usual Adult Dose for Peritonitis
International Society for Peritoneal Dialysis (ISPD) Recommendations:
Intermittent (1 exchange daily): 1000 mg intraperitoneally once a day
Continuous (all exchanges):
- Loading dose: 250 to 500 mg/L
- Maintenance dose: 100 to 125 mg/L
Duration of therapy: 3 weeks
Comments:
- Intermittent dosing is recommended and should be allowed to dwell for at least 6 hours.
- Prolonged courses of treatment should be avoided.
Use: Adjunctive treatment of peritonitis caused by P aeruginosa
Usual Pediatric Dose for Bacteremia
Empiric febrile neutropenia treatment:
2 months to 16 years up to 40 kg: 50 mg/kg via IV injection over 30 minutes every 8 hours
- Maximum dose: 2 grams/dose
16 to 18 years: 2 grams via IV injection over 30 minutes every 8 hours
Duration of therapy: 7 days OR until resolution of neutropenia
Bacteremia:
16 years and older:
- Pneumonia associated with bacteremia: 1 to 2 grams via IV injection over 30 minutes every 8 to 12 hours
- Mild to moderate UTIs associated with bacteremia: 0.5 to 1 gram via IV injection over 30 minutes every 12 hours
- Severe UTIs associated with bacteremia: 2 grams via IV injection over 30 minutes every 12 hours
Duration of therapy:
- Pneumonia: 10 days
- Mild to moderate UTIs: 7 to 10 days
- Severe UTIs: 10 days
Comments:
- The continued need for antibiotic treatment should be frequently reassessed in patients whose fever resolves but remain neutropenic for longer than 7 days.
- Use may be inappropriate in patients at high risk for severe infection (e.g., patients with a history of recent bone marrow transplantation, hypotension at presentation, underlying hematologic malignancy, with severe/prolonged neutropenia).
Uses:
- Monotherapy for empiric treatment of febrile neutropenia
- Treatment of moderate to severe pneumonia and concurrent bacteremia caused by susceptible strains of S pneumoniae, P aeruginosa, K pneumoniae, or Enterobacter species
- Treatment of complicated and uncomplicated mild to moderate urinary tract infections and concurrent bacteremia caused by susceptible isolates of E coli, K pneumoniae, or P mirabilis
- Treatment of complicated and uncomplicated severe urinary tract infections and concurrent bacteremia caused by susceptible isolates of E coli or K pneumoniae
IDSA:
Neonates 14 days and younger: 30 mg/kg IV every 12 hours
Infants older than 14 days: 50 mg/kg IV every 12 hours
Children 40 kg and less: 50 mg/kg IV every 12 hours
Comments:
- Preferred treatments may be given with or without aminoglycosides.
- Dosing recommendations were not provided for patients 2 weeks to 2 months of age.
Uses:
- Adjunctive preferred treatment of IV catheter-related bloodstream infections caused by P aeruginosa
- Alternative treatment of IV catheter-related bloodstream infections caused by Enterobacter species and S marcescens
Usual Pediatric Dose for Febrile Neutropenia
Empiric febrile neutropenia treatment:
2 months to 16 years up to 40 kg: 50 mg/kg via IV injection over 30 minutes every 8 hours
- Maximum dose: 2 grams/dose
16 to 18 years: 2 grams via IV injection over 30 minutes every 8 hours
Duration of therapy: 7 days OR until resolution of neutropenia
Bacteremia:
16 years and older:
- Pneumonia associated with bacteremia: 1 to 2 grams via IV injection over 30 minutes every 8 to 12 hours
- Mild to moderate UTIs associated with bacteremia: 0.5 to 1 gram via IV injection over 30 minutes every 12 hours
- Severe UTIs associated with bacteremia: 2 grams via IV injection over 30 minutes every 12 hours
Duration of therapy:
- Pneumonia: 10 days
- Mild to moderate UTIs: 7 to 10 days
- Severe UTIs: 10 days
Comments:
- The continued need for antibiotic treatment should be frequently reassessed in patients whose fever resolves but remain neutropenic for longer than 7 days.
- Use may be inappropriate in patients at high risk for severe infection (e.g., patients with a history of recent bone marrow transplantation, hypotension at presentation, underlying hematologic malignancy, with severe/prolonged neutropenia).
Uses:
- Monotherapy for empiric treatment of febrile neutropenia
- Treatment of moderate to severe pneumonia and concurrent bacteremia caused by susceptible strains of S pneumoniae, P aeruginosa, K pneumoniae, or Enterobacter species
- Treatment of complicated and uncomplicated mild to moderate urinary tract infections and concurrent bacteremia caused by susceptible isolates of E coli, K pneumoniae, or P mirabilis
- Treatment of complicated and uncomplicated severe urinary tract infections and concurrent bacteremia caused by susceptible isolates of E coli or K pneumoniae
IDSA:
Neonates 14 days and younger: 30 mg/kg IV every 12 hours
Infants older than 14 days: 50 mg/kg IV every 12 hours
Children 40 kg and less: 50 mg/kg IV every 12 hours
Comments:
- Preferred treatments may be given with or without aminoglycosides.
- Dosing recommendations were not provided for patients 2 weeks to 2 months of age.
Uses:
- Adjunctive preferred treatment of IV catheter-related bloodstream infections caused by P aeruginosa
- Alternative treatment of IV catheter-related bloodstream infections caused by Enterobacter species and S marcescens
Usual Pediatric Dose for Bacterial Infection
Empiric febrile neutropenia treatment:
2 months to 16 years up to 40 kg: 50 mg/kg via IV injection over 30 minutes every 8 hours
- Maximum dose: 2 grams/dose
16 to 18 years: 2 grams via IV injection over 30 minutes every 8 hours
Duration of therapy: 7 days OR until resolution of neutropenia
Bacteremia:
16 years and older:
- Pneumonia associated with bacteremia: 1 to 2 grams via IV injection over 30 minutes every 8 to 12 hours
- Mild to moderate UTIs associated with bacteremia: 0.5 to 1 gram via IV injection over 30 minutes every 12 hours
- Severe UTIs associated with bacteremia: 2 grams via IV injection over 30 minutes every 12 hours
Duration of therapy:
- Pneumonia: 10 days
- Mild to moderate UTIs: 7 to 10 days
- Severe UTIs: 10 days
Comments:
- The continued need for antibiotic treatment should be frequently reassessed in patients whose fever resolves but remain neutropenic for longer than 7 days.
- Use may be inappropriate in patients at high risk for severe infection (e.g., patients with a history of recent bone marrow transplantation, hypotension at presentation, underlying hematologic malignancy, with severe/prolonged neutropenia).
Uses:
- Monotherapy for empiric treatment of febrile neutropenia
- Treatment of moderate to severe pneumonia and concurrent bacteremia caused by susceptible strains of S pneumoniae, P aeruginosa, K pneumoniae, or Enterobacter species
- Treatment of complicated and uncomplicated mild to moderate urinary tract infections and concurrent bacteremia caused by susceptible isolates of E coli, K pneumoniae, or P mirabilis
- Treatment of complicated and uncomplicated severe urinary tract infections and concurrent bacteremia caused by susceptible isolates of E coli or K pneumoniae
IDSA:
Neonates 14 days and younger: 30 mg/kg IV every 12 hours
Infants older than 14 days: 50 mg/kg IV every 12 hours
Children 40 kg and less: 50 mg/kg IV every 12 hours
Comments:
- Preferred treatments may be given with or without aminoglycosides.
- Dosing recommendations were not provided for patients 2 weeks to 2 months of age.
Uses:
- Adjunctive preferred treatment of IV catheter-related bloodstream infections caused by P aeruginosa
- Alternative treatment of IV catheter-related bloodstream infections caused by Enterobacter species and S marcescens
Usual Pediatric Dose for Intraabdominal Infection
2 months to 16 years up to 40 kg:
Uncomplicated/complicated UTIs, uncomplicated skin and skin structure infections, and pneumonia: 50 mg/kg via IV injection over 30 minutes every 12 hours
- Maximum dose: 2 grams/dose
Moderate to severe pneumonia due to P aeruginosa: 50 mg/kg via IV injection over 30 minutes every 8 hours
- Maximum dose: 2 grams/dose
16 and older:
- Complicated intraabdominal infections OR moderate to severe pneumonia: 1 to 2 grams via IV injection over 30 minutes every 8 to 12 hours
- Intraabdominal infections OR pneumonia caused by Pseudomonas aeruginosa: 2 grams via IV injection over 30 minutes every 8 hours
Duration of therapy:
- Abdominal infections OR mild to moderate UTIs: 7 to 10 days
- Severe UTIs or pneumonia: 10 days
Comment: Mild to moderate uncomplicated and complicated UTIs caused by E coli may be treated via IM administration; other isolates should be treated via IV administration.
Uses:
- Treatment of complicated and uncomplicated mild to moderate UTIs caused by susceptible isolates of E coli, K pneumoniae, or P mirabilis
- Treatment of complicated and uncomplicated severe urinary tract infections caused by susceptible isolates of E coli or K pneumoniae
- Treatment of pyelonephritis
- Treatment of uncomplicated skin and skin structure infections caused by S aureus (only methicillin susceptible isolates) or S pyogenes
- Treatment of moderate to severe uncomplicated skin and skin structure infections caused by MSSA or S pyogenes
- Treatment of moderate to severe pneumonia caused by susceptible strains of Enterobacter species, K pneumoniae, P aeruginosa, or S pneumoniae
SIS and IDSA Recommendations:
Initial dose: 50 mg/kg IV every 12 hours PLUS metronidazole
Comment: Maintenance doses should be based on adjusted body weight and serum drug concentrations.
Use: Empiric combination treatment of complicated extra-biliary community-acquired intraabdominal infections in patients with severe physiologic disturbance, advanced age, or immunocompromised stage caused by ESBL-producing Enterobacteriaceae or P aeruginosa, or GNB less than 20% resistant to this drug and metronidazole
Usual Pediatric Dose for Pneumonia
2 months to 16 years up to 40 kg:
Uncomplicated/complicated UTIs, uncomplicated skin and skin structure infections, and pneumonia: 50 mg/kg via IV injection over 30 minutes every 12 hours
- Maximum dose: 2 grams/dose
Moderate to severe pneumonia due to P aeruginosa: 50 mg/kg via IV injection over 30 minutes every 8 hours
- Maximum dose: 2 grams/dose
16 and older:
- Complicated intraabdominal infections OR moderate to severe pneumonia: 1 to 2 grams via IV injection over 30 minutes every 8 to 12 hours
- Intraabdominal infections OR pneumonia caused by Pseudomonas aeruginosa: 2 grams via IV injection over 30 minutes every 8 hours
Duration of therapy:
- Abdominal infections OR mild to moderate UTIs: 7 to 10 days
- Severe UTIs or pneumonia: 10 days
Comment: Mild to moderate uncomplicated and complicated UTIs caused by E coli may be treated via IM administration; other isolates should be treated via IV administration.
Uses:
- Treatment of complicated and uncomplicated mild to moderate UTIs caused by susceptible isolates of E coli, K pneumoniae, or P mirabilis
- Treatment of complicated and uncomplicated severe urinary tract infections caused by susceptible isolates of E coli or K pneumoniae
- Treatment of pyelonephritis
- Treatment of uncomplicated skin and skin structure infections caused by S aureus (only methicillin susceptible isolates) or S pyogenes
- Treatment of moderate to severe uncomplicated skin and skin structure infections caused by MSSA or S pyogenes
- Treatment of moderate to severe pneumonia caused by susceptible strains of Enterobacter species, K pneumoniae, P aeruginosa, or S pneumoniae
SIS and IDSA Recommendations:
Initial dose: 50 mg/kg IV every 12 hours PLUS metronidazole
Comment: Maintenance doses should be based on adjusted body weight and serum drug concentrations.
Use: Empiric combination treatment of complicated extra-biliary community-acquired intraabdominal infections in patients with severe physiologic disturbance, advanced age, or immunocompromised stage caused by ESBL-producing Enterobacteriaceae or P aeruginosa, or GNB less than 20% resistant to this drug and metronidazole
Usual Pediatric Dose for Pyelonephritis
2 months to 16 years up to 40 kg:
Uncomplicated/complicated UTIs, uncomplicated skin and skin structure infections, and pneumonia: 50 mg/kg via IV injection over 30 minutes every 12 hours
- Maximum dose: 2 grams/dose
Moderate to severe pneumonia due to P aeruginosa: 50 mg/kg via IV injection over 30 minutes every 8 hours
- Maximum dose: 2 grams/dose
16 and older:
- Complicated intraabdominal infections OR moderate to severe pneumonia: 1 to 2 grams via IV injection over 30 minutes every 8 to 12 hours
- Intraabdominal infections OR pneumonia caused by Pseudomonas aeruginosa: 2 grams via IV injection over 30 minutes every 8 hours
Duration of therapy:
- Abdominal infections OR mild to moderate UTIs: 7 to 10 days
- Severe UTIs or pneumonia: 10 days
Comment: Mild to moderate uncomplicated and complicated UTIs caused by E coli may be treated via IM administration; other isolates should be treated via IV administration.
Uses:
- Treatment of complicated and uncomplicated mild to moderate UTIs caused by susceptible isolates of E coli, K pneumoniae, or P mirabilis
- Treatment of complicated and uncomplicated severe urinary tract infections caused by susceptible isolates of E coli or K pneumoniae
- Treatment of pyelonephritis
- Treatment of uncomplicated skin and skin structure infections caused by S aureus (only methicillin susceptible isolates) or S pyogenes
- Treatment of moderate to severe uncomplicated skin and skin structure infections caused by MSSA or S pyogenes
- Treatment of moderate to severe pneumonia caused by susceptible strains of Enterobacter species, K pneumoniae, P aeruginosa, or S pneumoniae
SIS and IDSA Recommendations:
Initial dose: 50 mg/kg IV every 12 hours PLUS metronidazole
Comment: Maintenance doses should be based on adjusted body weight and serum drug concentrations.
Use: Empiric combination treatment of complicated extra-biliary community-acquired intraabdominal infections in patients with severe physiologic disturbance, advanced age, or immunocompromised stage caused by ESBL-producing Enterobacteriaceae or P aeruginosa, or GNB less than 20% resistant to this drug and metronidazole
Usual Pediatric Dose for Urinary Tract Infection
2 months to 16 years up to 40 kg:
Uncomplicated/complicated UTIs, uncomplicated skin and skin structure infections, and pneumonia: 50 mg/kg via IV injection over 30 minutes every 12 hours
- Maximum dose: 2 grams/dose
Moderate to severe pneumonia due to P aeruginosa: 50 mg/kg via IV injection over 30 minutes every 8 hours
- Maximum dose: 2 grams/dose
16 and older:
- Complicated intraabdominal infections OR moderate to severe pneumonia: 1 to 2 grams via IV injection over 30 minutes every 8 to 12 hours
- Intraabdominal infections OR pneumonia caused by Pseudomonas aeruginosa: 2 grams via IV injection over 30 minutes every 8 hours
Duration of therapy:
- Abdominal infections OR mild to moderate UTIs: 7 to 10 days
- Severe UTIs or pneumonia: 10 days
Comment: Mild to moderate uncomplicated and complicated UTIs caused by E coli may be treated via IM administration; other isolates should be treated via IV administration.
Uses:
- Treatment of complicated and uncomplicated mild to moderate UTIs caused by susceptible isolates of E coli, K pneumoniae, or P mirabilis
- Treatment of complicated and uncomplicated severe urinary tract infections caused by susceptible isolates of E coli or K pneumoniae
- Treatment of pyelonephritis
- Treatment of uncomplicated skin and skin structure infections caused by S aureus (only methicillin susceptible isolates) or S pyogenes
- Treatment of moderate to severe uncomplicated skin and skin structure infections caused by MSSA or S pyogenes
- Treatment of moderate to severe pneumonia caused by susceptible strains of Enterobacter species, K pneumoniae, P aeruginosa, or S pneumoniae
SIS and IDSA Recommendations:
Initial dose: 50 mg/kg IV every 12 hours PLUS metronidazole
Comment: Maintenance doses should be based on adjusted body weight and serum drug concentrations.
Use: Empiric combination treatment of complicated extra-biliary community-acquired intraabdominal infections in patients with severe physiologic disturbance, advanced age, or immunocompromised stage caused by ESBL-producing Enterobacteriaceae or P aeruginosa, or GNB less than 20% resistant to this drug and metronidazole
Usual Pediatric Dose for Skin and Structure Infection
2 months to 16 years up to 40 kg:
Uncomplicated/complicated UTIs, uncomplicated skin and skin structure infections, and pneumonia: 50 mg/kg via IV injection over 30 minutes every 12 hours
- Maximum dose: 2 grams/dose
Moderate to severe pneumonia due to P aeruginosa: 50 mg/kg via IV injection over 30 minutes every 8 hours
- Maximum dose: 2 grams/dose
16 and older:
- Complicated intraabdominal infections OR moderate to severe pneumonia: 1 to 2 grams via IV injection over 30 minutes every 8 to 12 hours
- Intraabdominal infections OR pneumonia caused by Pseudomonas aeruginosa: 2 grams via IV injection over 30 minutes every 8 hours
Duration of therapy:
- Abdominal infections OR mild to moderate UTIs: 7 to 10 days
- Severe UTIs or pneumonia: 10 days
Comment: Mild to moderate uncomplicated and complicated UTIs caused by E coli may be treated via IM administration; other isolates should be treated via IV administration.
Uses:
- Treatment of complicated and uncomplicated mild to moderate UTIs caused by susceptible isolates of E coli, K pneumoniae, or P mirabilis
- Treatment of complicated and uncomplicated severe urinary tract infections caused by susceptible isolates of E coli or K pneumoniae
- Treatment of pyelonephritis
- Treatment of uncomplicated skin and skin structure infections caused by S aureus (only methicillin susceptible isolates) or S pyogenes
- Treatment of moderate to severe uncomplicated skin and skin structure infections caused by MSSA or S pyogenes
- Treatment of moderate to severe pneumonia caused by susceptible strains of Enterobacter species, K pneumoniae, P aeruginosa, or S pneumoniae
SIS and IDSA Recommendations:
Initial dose: 50 mg/kg IV every 12 hours PLUS metronidazole
Comment: Maintenance doses should be based on adjusted body weight and serum drug concentrations.
Use: Empiric combination treatment of complicated extra-biliary community-acquired intraabdominal infections in patients with severe physiologic disturbance, advanced age, or immunocompromised stage caused by ESBL-producing Enterobacteriaceae or P aeruginosa, or GNB less than 20% resistant to this drug and metronidazole
Usual Pediatric Dose for Meningitis
IDSA, AAN, AANS, and NCS Recommendations:
50 mg/kg IV every 8 hours
Duration of therapy:
- N meningitis or H influenzae: 7 days
- Coagulase-negative staphylococcus or P acnes with no/minimal CSF pleocytosis, normal CSF glucose, few symptoms/systemic features: 10 days
- Coagulase-negative staphylococcus or P acnes with significant CSF pleocytosis, S aureus or GNB with/without significant CSF pleocytosis, CSF hypengyophobically, or symptoms/systemic features: 10 to 14 days
- S pneumoniae: 10 to 14 days
- S agalactiae: 14 to 21 days
- Aerobic GNB: 21 days
- L monocytogenes: At least 21 days
- Repeatedly positive CSF cultures on appropriate antimicrobial treatment: Continue treatment for 10 to 14 days after the last positive culture
Comments:
- Neonates weighing less than 2000 grams may require lower doses and/or longer dosage intervals.
- The duration of treatment in neonates should be 2 weeks beyond the first sterile CSF culture OR at least 3 weeks of treatment, whichever is longer.
Uses:
- Standard treatment of healthcare-associated ventriculitis and meningitis caused by P aeruginosa
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by S pneumoniae with a penicillin MIC at least 0.12 mcg/mL AND a cefotaxime/ceftriaxone MIC less than 1 mcg/mL
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by beta-lactamase negative H influenzae
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by ESBL GNB
Usual Pediatric Dose for Meningitis - Meningococcal
IDSA, AAN, AANS, and NCS Recommendations:
50 mg/kg IV every 8 hours
Duration of therapy:
- N meningitis or H influenzae: 7 days
- Coagulase-negative staphylococcus or P acnes with no/minimal CSF pleocytosis, normal CSF glucose, few symptoms/systemic features: 10 days
- Coagulase-negative staphylococcus or P acnes with significant CSF pleocytosis, S aureus or GNB with/without significant CSF pleocytosis, CSF hypengyophobically, or symptoms/systemic features: 10 to 14 days
- S pneumoniae: 10 to 14 days
- S agalactiae: 14 to 21 days
- Aerobic GNB: 21 days
- L monocytogenes: At least 21 days
- Repeatedly positive CSF cultures on appropriate antimicrobial treatment: Continue treatment for 10 to 14 days after the last positive culture
Comments:
- Neonates weighing less than 2000 grams may require lower doses and/or longer dosage intervals.
- The duration of treatment in neonates should be 2 weeks beyond the first sterile CSF culture OR at least 3 weeks of treatment, whichever is longer.
Uses:
- Standard treatment of healthcare-associated ventriculitis and meningitis caused by P aeruginosa
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by S pneumoniae with a penicillin MIC at least 0.12 mcg/mL AND a cefotaxime/ceftriaxone MIC less than 1 mcg/mL
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by beta-lactamase negative H influenzae
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by ESBL GNB
Usual Pediatric Dose for Meningitis - Haemophilus influenzae
IDSA, AAN, AANS, and NCS Recommendations:
50 mg/kg IV every 8 hours
Duration of therapy:
- N meningitis or H influenzae: 7 days
- Coagulase-negative staphylococcus or P acnes with no/minimal CSF pleocytosis, normal CSF glucose, few symptoms/systemic features: 10 days
- Coagulase-negative staphylococcus or P acnes with significant CSF pleocytosis, S aureus or GNB with/without significant CSF pleocytosis, CSF hypengyophobically, or symptoms/systemic features: 10 to 14 days
- S pneumoniae: 10 to 14 days
- S agalactiae: 14 to 21 days
- Aerobic GNB: 21 days
- L monocytogenes: At least 21 days
- Repeatedly positive CSF cultures on appropriate antimicrobial treatment: Continue treatment for 10 to 14 days after the last positive culture
Comments:
- Neonates weighing less than 2000 grams may require lower doses and/or longer dosage intervals.
- The duration of treatment in neonates should be 2 weeks beyond the first sterile CSF culture OR at least 3 weeks of treatment, whichever is longer.
Uses:
- Standard treatment of healthcare-associated ventriculitis and meningitis caused by P aeruginosa
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by S pneumoniae with a penicillin MIC at least 0.12 mcg/mL AND a cefotaxime/ceftriaxone MIC less than 1 mcg/mL
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by beta-lactamase negative H influenzae
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by ESBL GNB
Usual Pediatric Dose for Meningitis - Pneumococcal
IDSA, AAN, AANS, and NCS Recommendations:
50 mg/kg IV every 8 hours
Duration of therapy:
- N meningitis or H influenzae: 7 days
- Coagulase-negative staphylococcus or P acnes with no/minimal CSF pleocytosis, normal CSF glucose, few symptoms/systemic features: 10 days
- Coagulase-negative staphylococcus or P acnes with significant CSF pleocytosis, S aureus or GNB with/without significant CSF pleocytosis, CSF hypengyophobically, or symptoms/systemic features: 10 to 14 days
- S pneumoniae: 10 to 14 days
- S agalactiae: 14 to 21 days
- Aerobic GNB: 21 days
- L monocytogenes: At least 21 days
- Repeatedly positive CSF cultures on appropriate antimicrobial treatment: Continue treatment for 10 to 14 days after the last positive culture
Comments:
- Neonates weighing less than 2000 grams may require lower doses and/or longer dosage intervals.
- The duration of treatment in neonates should be 2 weeks beyond the first sterile CSF culture OR at least 3 weeks of treatment, whichever is longer.
Uses:
- Standard treatment of healthcare-associated ventriculitis and meningitis caused by P aeruginosa
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by S pneumoniae with a penicillin MIC at least 0.12 mcg/mL AND a cefotaxime/ceftriaxone MIC less than 1 mcg/mL
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by beta-lactamase negative H influenzae
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by ESBL GNB
Usual Pediatric Dose for Meningitis - Listeriosis
IDSA, AAN, AANS, and NCS Recommendations:
50 mg/kg IV every 8 hours
Duration of therapy:
- N meningitis or H influenzae: 7 days
- Coagulase-negative staphylococcus or P acnes with no/minimal CSF pleocytosis, normal CSF glucose, few symptoms/systemic features: 10 days
- Coagulase-negative staphylococcus or P acnes with significant CSF pleocytosis, S aureus or GNB with/without significant CSF pleocytosis, CSF hypengyophobically, or symptoms/systemic features: 10 to 14 days
- S pneumoniae: 10 to 14 days
- S agalactiae: 14 to 21 days
- Aerobic GNB: 21 days
- L monocytogenes: At least 21 days
- Repeatedly positive CSF cultures on appropriate antimicrobial treatment: Continue treatment for 10 to 14 days after the last positive culture
Comments:
- Neonates weighing less than 2000 grams may require lower doses and/or longer dosage intervals.
- The duration of treatment in neonates should be 2 weeks beyond the first sterile CSF culture OR at least 3 weeks of treatment, whichever is longer.
Uses:
- Standard treatment of healthcare-associated ventriculitis and meningitis caused by P aeruginosa
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by S pneumoniae with a penicillin MIC at least 0.12 mcg/mL AND a cefotaxime/ceftriaxone MIC less than 1 mcg/mL
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by beta-lactamase negative H influenzae
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by ESBL GNB
Usual Pediatric Dose for Meningitis - Streptococcus Group B
IDSA, AAN, AANS, and NCS Recommendations:
50 mg/kg IV every 8 hours
Duration of therapy:
- N meningitis or H influenzae: 7 days
- Coagulase-negative staphylococcus or P acnes with no/minimal CSF pleocytosis, normal CSF glucose, few symptoms/systemic features: 10 days
- Coagulase-negative staphylococcus or P acnes with significant CSF pleocytosis, S aureus or GNB with/without significant CSF pleocytosis, CSF hypengyophobically, or symptoms/systemic features: 10 to 14 days
- S pneumoniae: 10 to 14 days
- S agalactiae: 14 to 21 days
- Aerobic GNB: 21 days
- L monocytogenes: At least 21 days
- Repeatedly positive CSF cultures on appropriate antimicrobial treatment: Continue treatment for 10 to 14 days after the last positive culture
Comments:
- Neonates weighing less than 2000 grams may require lower doses and/or longer dosage intervals.
- The duration of treatment in neonates should be 2 weeks beyond the first sterile CSF culture OR at least 3 weeks of treatment, whichever is longer.
Uses:
- Standard treatment of healthcare-associated ventriculitis and meningitis caused by P aeruginosa
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by S pneumoniae with a penicillin MIC at least 0.12 mcg/mL AND a cefotaxime/ceftriaxone MIC less than 1 mcg/mL
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by beta-lactamase negative H influenzae
- Alternative treatment of healthcare-associated ventriculitis and meningitis caused by ESBL GNB
Usual Pediatric Dose for Peritonitis
ISPD Recommendations:
Continuous peritoneal dialysis:
- Loading dose: 500 mg/L
- Maintenance dose: 125 mg/L
Intermittent peritoneal dialysis: 15 mg/kg intraperitoneally once a day
Duration of therapy:
- Coagulase-negative staphylococci OR Streptococcus species: 2 weeks
- E coli OR Klebsiella species: 2 weeks
- E coli OR Klebsiella species resistant to third-generation cephalosporins: 3 weeks
- Acinetobacter species: 2 to 3 weeks
- Enterobacter, Citrobacter, Serratia, and Proteus species: At least 2 to 3 weeks
- MSSA: 3 weeks
- Pseudomonas species: 3 weeks
Comments:
- Continuous: Loading doses should be allowed to dwell for at least 3 to 6 hours.
- Intermittent: Doses should be administered via the long-dwell (unless otherwise specified) and be allowed to dwell for at least 6 hours.
- If initial cultures remain sterile at 72 hours and signs/symptoms of peritonitis improve, treatment may continue for 2 weeks.
- Prolonged courses of treatment should be avoided.
Uses:
- Preferred empiric treatment of peritonitis caused by gram-positive bacteria
- Adjunctive treatment (with an aminoglycoside) of peritonitis caused by S aureus with resistance rates to methicillin or oxacillin exceeding 10% OR in patients with a history of MRSA
- Treatment of peritonitis caused by susceptible gram-negative bacteria (e.g., E coli, Proteus species, or Klebsiella species)
- Adjunctive treatment of peritonitis caused by P aeruginosa
Usual Pediatric Dose for Endocarditis
AHA Recommendations:
Early, culture-negative endocarditis: 150 mg/kg per day, given in divided doses 3 times per day PLUS vancomycin, gentamicin, AND rifampin
Nosocomial endocarditis: 100 to 150 mg/kg IV per day, given in divided doses every 8 to 12 hours
- Maximum dose: 6 grams/day
Duration of therapy: At least 6 weeks
Comment: Gentamicin should be added to patients with enterococci infections.
Uses:
- Empiric alternative treatment (with gentamicin) of community-acquired native valve or late prosthetic valve (over 1 year after surgery) endocarditis
- Empiric treatment of nosocomial endocarditis associated with vascular cannula or early prosthetic valve endocarditis (1 year or less after surgery)
- Adjunctive empiric treatment of nosocomial endocarditis associated with gram-negative enteric bacilli
- Empiric treatment in early, culture-negative, prosthetic valve endocarditis
- Alternative treatment for streptococcal infections highly susceptible to penicillin G (e.g., groups A, B, C, G nonenterococcal, group D streptococci) and streptococci relatively resistant to penicillin (e.g., enterococci, less-susceptible VGS)
- Alternative treatment for endocarditis caused by S aureus or coagulase-negative staphylococci susceptible or resistant to penicillin G and/or oxacillin in patients highly allergic to beta-lactam antibiotics
Renal Dose Adjustments
Pediatric patients: Dose adjustment(s) may be required; however, no specific guidelines have been suggested. The manufacturer recommends dosage regimen changes proportional to those in adults.
Adults:
Initial dose:
- Patients with renal dysfunction and not undergoing hemodialysis: No adjustment recommended.
Maintenance dose:
Mild infections:
- CrCl greater than 60 mL/min: 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 less than 11 mL/min: 250 mg IV every 24 hours
Moderate infections:
- CrCl greater than 60 mL/min: 1 gram IV every 12 hours
- CrCl 30 to 60 mL/min: 1 gram IV every 24 hours
- CrCl 11 to 29 mL/min: 500 mg IV every 24 hours
- CrCl less than 11 mL/min: 250 mg IV every 24 hours
Severe infections:
- CrCl greater than 60 mL/min: 2 grams IV every 12 hours
- CrCl 30 to 60 mL/min: 2 grams IV every 24 hours
- CrCl 11 to 29 mL/min: 1 gram IV every 24 hours
- CrCl less than 11 mL/min: 500 mg IV every 24 hours
Life-threatening infections:
- CrCl greater than 60 mL/min: 2 grams IV every 8 hours
- CrCl 30 to 60 mL/min: 2 grams IV every 12 hours
- CrCl 11 to 29 mL/min: 2 grams IV every 24 hours
- CrCl less than 11 mL/min: 1 gram IV every 24 hours
Liver Dose Adjustments
No adjustment recommended.
Precautions
CONTRAINDICATIONS:
- Immediate hypersensitivity to the active component, cephalosporin antibiotics, other beta-lactam antibiotics, penicillins, or to any of the ingredients
- Patients with a known allergy to corn/corn products should not take injection solutions containing dextrose
Safety and efficacy have not been established in patients younger than 2 months.
Consult WARNINGS section for additional precautions.
Dialysis
Continuous ambulatory peritoneal dialysis (CAPD):
- Mild infection: 500 mg IV every 48 hours
- Moderate infection: 1 gram IV every 48 hours
- Severe/life-threatening infection: 2 grams IV every 48 hours
Hemodialysis:
Loading dose: 1 gram IV ONCE
Maintenance dose:
- Febrile neutropenia: 1 gram IV every 24 hours
- All other infections: 500 mg IV every 24 hours
Comments:
- Maintenance doses for patients receiving hemodialysis should be given following hemodialysis.
- When possible, doses should be given at the same time each day.
Other Comments
Administration advice:
- Once prepared, this drug should be administered immediately or as soon as possible after reconstitution.
- IM: This drug should be injected deep into the body of a large muscle.
- IV: This drug should be infused over at least 30 minutes.
Storage requirements:
- Protect from light.
- The manufacturer product information should be consulted.
Reconstitution/preparation techniques:
- IM: Providers may constitute this drug with 0.5% or 1% lidocaine (lignocaine); however, this drug usually causes little to no pain with IM administration.
IV compatibility:
- Compatible diluents and IV solutions: Dextrose 5% injection; glucose 5% and lactated Ringer's injection; glucose 5% with sodium chloride 0.9% injection/solution; lidocaine (lignocaine) 0.5% or 1% injection; M/6 sodium lactate injection; Ringer lactate solution; Ringer lactate with glucose 5% solution; sodium chloride 0.9% solution; sodium lactate 1/6M solution; sterile glucose 5% injection; sterile glucose 5% or 10% solution; sterile water for injection
General:
- Local epidemiological and susceptibility patterns should be used to guide treatment selection in the absence of patient-specific culture and susceptibility information.
Monitoring:
- HEMATOLOGIC: WBC count, especially in patients receiving empiric treatment for neutropenia
- RENAL: Renal function tests, especially when used concomitantly with high doses of aminoglycosides and/or potent diuretics
Patient advice:
- Inform patients that this drug may cause altered consciousness, confusion, dizziness, or hallucinations, and they should avoid driving or operating machinery if these side effects occur.
- Advise patients to speak to their healthcare provider if they become pregnant, intend to become pregnant, or are breastfeeding.
- Patients should be directed to take the full course of treatment, even if they feel better.
- Patients should be instructed to report signs/symptoms of Clostridium difficile (e.g., watery/bloody stools, stomach cramps, fever), for up to 2 months after stopping treatment.
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