Adult Dosing
Moderate to severe pneumonia
- 1-2 g IV q12 hrs x 10 days
Febrile neutropenia
Urinary tract infections, mild to moderate
- 0.5-1 g IV/IM q12 hrs x 7-10 days
- IM route only for infections due to E.coli
Urinary tract infections, severe
Skin and skin structure infections, moderate to severe
Complicated intra-abdominal infections
- 2 g IV q12 hrs x 7-10 days
Bacterial Meningitis [Non-FDA approved]
Pediatric Dosing
Bacterial infections
- 100 mg/kg/day IV/IM divided q12 hrs x 7-10 days
- Max: 2 g/dose; 4 g/day
- IM route only for mild-moderated UTI due to E.coli
Febrile neutropenia
- 150 mg/kg/day IV divided q8 hrs x 7 days
- Max: 2 g/dose; 4 g/day
Bacterial Meningitis [Non-FDA approved]
- 50 mg/kg IV q12 hrs (Max 2 grams/dose)
[Outline]
Renal Dose Adjustment (Based on CrCl)
Adults
- 30-60 mL/min
- If recommended dosage is 0.5 g q12 hrs: give 0.5 g q24 hrs
- If recommended dosage is 1 g q12 hrs: give 1 g q24 hrs
- If recommended dosage is 2 g q12 hrs: give 2 g q24 hrs
- If recommended dosage is 2 g q8 hrs: give 2 g q12 hrs
- 11-29 mL/min
- If recommended dosage is 0.5 g q12 hrs: give 0.5 g q24 hrs
- If recommended dosage is 1 g q12 hrs: give 0.5 g q24 hrs
- If recommended dosage is 2 g q12 hrs: give 1 g q24 hrs
- If recommended dosage is 2 g q8 hrs: give 2 g q24 hrs
- < 11 mL/min
- If recommended dosage is 0.5 g q12 hrs: give 0.25 g q24 hrs
- If recommended dosage is 1 g q12 hrs: give 0.25 g q24 hrs
- If recommended dosage is 2 g q12 hrs: give 0.5 g q24 hrs
- If recommended dosage is 2 g q8 hrs: give 1 g q24 hrs
- CAPD
- If recommended dosage is 0.5 g q12 hrs: give 0.5 g q48 hrs
- If recommended dosage is 1 g q12 hrs: give 1 g q48 hrs
- If recommended dosage is 2 g q12 hrs: give 2 g q48 hrs
- If recommended dosage is 2 g q8 hrs: give 2g q48 hrs
- Hemodialysis: 1 g on day 1, then 0.5 mg q24 hrs thereafter
Child
- Modify dosing consistent with reccomendations for adults
Hepatic Dose Adjustment
- Before starting therapy with cefepime, carefully inquire if patients have had previous hypersensitivity to cephalosporins, penicillins or other b-lactams. Extreme caution must be exercised as cross reactivity among beta-lactams is clearly documented and may occur in up to 10% of patients
- Clostridium difficile associated diarrhea which may vary in severity from mild to fatal colitis, has been reported with use of cefipime
- Cefipime should be used to treat infections that are proven or strongly suspected to be caused by susceptible bacteria. Prescribing in the absence of a proven or strongly suspected bacterial infection increases the risk of the development of drug-resistant bacteria
- Prolonged use may result in the overgrowth of nonsusceptible organisms
- Post marketing studies related to neurotoxicity including encephalopathy, myoclonus, seizures, and nonconvulsive status epilepticus have been reported mainly in patients receiving inadequate dosing adjustment for renal impairment, and few cases in patients receiving dosage adjustment appropriate for their degree of renal impairment. If neurotoxicity is associated with the therapy, then consider discontinuing the treatment or make appropriate dose adjustment in patients with renal impairment
Cautions: Use cautiously in
- Renal impairment
- Hypersensitivity to penicillins
- Hx of GI disease
- Hx of antibiotic associated colitis
- Concurrent nephrotoxic agents
- Seizure disorder
- H. influenzae infection in pediatric patients
Pregnancy Category:B
Breatfeeding: Safety unknown. No information available for the use of cefepime during breastfeeding. However, cephalosporins are generally not expected to cause adverse effects in breastfed infants. This information is based upon data from LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 14 May 2010). Manufacturer advises caution
