Criteria & Principles
- Empiric or definitive treatment of serious infections due to Gram negative organisms sensitive to cefepime, including but not limited to P. aeruginosa and other AmpC-producing strains (eg, Enterobacter, Citrobacter, Serratia)
- Empiric treatment of febrile neutropenia (see attached guidelines)
- Worried about cefepime-induced neurotoxicity? See attachment section for a literature review of this topic.
Adjustment of Dose & Administration
Indication-Specific Adjustment
| Indication/Population/Pathogen | CrCl (infusion time) | ||||
| >50 mL/min | 30-49 mL/min | 15-29 mL/min | <15 mL/min, Peritoneal dialysis or IHD | CRRT | |
| Urinary tract infections (complicated) | 1g q12h [0.5hr] | 1g q24h [0.5hr] | 1g q24h [0.5hr] | 500mg q24h (give dose after HD) [0.5hr] | 1g q12h [0.5hr] |
|
Bacteremia Pneumonia Intra-abdominal infections Skin and skin structure |
1g q6h [0.5hr] | 1g q8h [0.5hr] | 1g q12h [0.5hr] |
1g q24h (give dose after HD) [0.5hr] OR 2g/2g/3g three times weekly post HD [0.5hr] |
1g q8h [0.5hr] |
|
Bone and joint infections Cystic fibrosis Febrile neutropenia CNS infections Necrotizing fasciitis MDR Pseudomonas/Acinetobacter susceptible to cefepime Susceptible Dose Dependent (SDD) organisms |
2g q8h [4hr] | 2g q12h [4hr] | 1g q12h [4hr] | 1g q24h (give dose after HD) [4hr] | 2g q12h [4hr] |
Note: Beta-lactam antibiotics exhibit time-dependent killing. Use of extended infusion optimizes the probability that drug concentrations will remain above the minimum inhibitory concentration (MIC) of the infecting organsim for an appropriate period of time in severe infections. Consider initiating extended infusion regimen with 1x dose over 30min followed by extended infusion (timed to start at dosing interval) for patients who are critically ill.
Drug-Specific Information
Loading doses: an initial loading dose may be given over 0.5 hours. This approach may be particularly useful to achieve faster target attainment in immunocompromised patients or in patients with previously documented Pseudomonas organisms with higher MIC distribution. Of note, administering loading doses has not been shown to decrease mortality or time to clinical improvement compared to initiating therapy with an extended infusion.
Y-site compatibility with vancomycin: cefepime 2g in 100mL Mini-Bag Plus system containing either NS or D5W was compatible with vancomycin concentrations less than or equal to 4mg/mL in NS and less than or equal to 5mg/mL in D5W. Higher concentrations of cefepime and vancomycin have been studied with variable results. Therefore, it can be recommended to Y-site vancomycin at concentrations of ≤ 4mg/mL in NS and ≤ 5 mg/mL in D5W with cefepime 1g or 2g to help resolve medication scheduling issues.
Dose Adjustments by Pharmacists: Orders for traditional doses/administration of cefepime for adults will be interchanged with alternate/extended dosing. Pharmacists may automatically interchange traditional dosing cefepime orders and adjust the dose of cefepime as indicated in the guideline for renal adjustment. Orders will be adjusted “per protocol, no cosign required.” If there is any question about the indication for cefepime, the prescriber should be contacted for clarification.
Please find optimal dosing recommendations here.
Concerned about Beta lactam neurotoxicity? See the attachment section for more details
General Notes
- Up to date cost information for select antimicrobials can be found on the Antimicrobial Cost Chart page.
- Information about how to administer select IV antimicrobials outpatient (OPAT) is found on the Outpatient Antibiotic Administration Chart page.
- When dosing guidance is provided it is important to note the following:
Fixed (i.e. non-weight-based) doses in adults are historically based on a 70 kg patient. Specific disease states or individual patients may warrant dosages that differ from the above recommendations. Since product-specific criteria for dose adjustment based on creatinine clearance exist, consult product information regarding specific recommendations for dosage adjustment based on estimated creatinine clearance.