Cefepime

Usual Dosing (Adults)

[Mild to moderate]: 500 mg to 1 gram IV q12h.
[Moderate to severe]: 1-2 grams IV q12h.
[Febrile neutropenic patients]: 2 grams IV q8h.

Recommended Dosage Schedule for MAXIPIME in Patients with CrCL >60 mL/min.

Site and Type of Infection	Dose	Frequency	Duration (days)
Adults
*including cases associated with concurrent bacteremia
**or until resolution of neutropenia. In patients whose fever resolves but who remain neutropenic for more than 7 days, the need for continued antimicrobial therapy should be re-evaluated frequently.
***IM route of administration is indicated only for mild to moderate, uncomplicated or complicated UTI’s due to E. coli when the IM route is considered to be a more appropriate route of drug administration.
Moderate to Severe Pneumonia due to S. pneumoniae*, P. aeruginosa, K. pneumoniae, or Enterobacter species	1-2 g IV	q12h	10
Empiric therapy for febrile neutropenic patients	2 g IV	q8h	7**
Mild to Moderate Uncomplicated or Complicated Urinary Tract Infections, including pyelonephritis, due to E. coli, K. pneumoniae, or P. mirabilis*	0.5-1 g IV/IM***	q12h	7-10
Severe Uncomplicated or Complicated Urinary Tract Infections, including pyelonephritis, due to E. coli or K. pneumoniae*	2 g IV	q12h	10
Moderate to Severe Uncomplicated Skin and Skin Structure Infections due to S. aureus or S. pyogenes	2 g IV	q12h	10
Complicated Intra-abdominal Infections (used in combination with metronidazole) caused by E. coli, viridans group streptococci, P. aeruginosa, K. pneumoniae, Enterobacter species, or B. fragilis.	2 g IV	q12h	7-10
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/kg/dose, administered q12h (50 mg/kg/dose, q8h for febrile neutropenic patients), for durations as given above.

Renal Dosing

[CRCL >60 ml/min]: no change.

[30-60 ]: 500mg to 2 grams q24h.
Neutropenic: 2 grams q12h.

[11-29 ]: 500 mg to 1 gram q24h. Neutropenic: 2 grams q24h.

[<11 ]: 250 – 500 mg q24h. Neutropenic: 1 gram q24h.

Impaired Renal Function
In patients with impaired renal function (creatinine clearance =60 mL/min), the dose of MAXIPIME should be adjusted to compensate for the slower rate of renal elimination. The recommended initial dose of MAXIPIME should be the same as in patients with normal renal function except in patients undergoing hemodialysis.

Recommended Dosing Schedule for MAXIPIME in Adult Patients (Normal Renal Function, Renal Insufficiency, and Hemodialysis)

Creatinine Clearance (mL/min)	Recommended Maintenance Schedule
>60 Normal recommended dosing schedule	500 mg q12h	1 g q12h	2 g q12h	2 g q8h
30-60	500 mg q24h	1 g q24h	2 g q24h	2 g q12h
11-29	500 mg q24h	500 mg q24h	1 g q24h	2 g q24h
<11	250 mg q24h	250 mg q24h	500 mg q24h	1 g q24h
CAPD	500 mg q48h	1 g q48h	2 g q48h	2g q48h
Hemodialysis*	1 g on day 1, then 500 mg q24h thereafter			1 g q24h
*On hemodialysis days, cefepime should be administered following hemodialysis. Whenever possible, cefepime should be administered at the same time each day.

Hemodialysis

Hemodialysis:
See table above.

In patients undergoing hemodialysis, approximately 68% of the total amount of cefepime present in the body at the start of dialysis will be removed during a 3-hour dialysis period. The dosage of cefepime for injection for hemodialysis patients is 1 g on Day 1 followed by 500 mg every 24 hours for the treatment of all infections except febrile neutropenia, which is 1 g every 24 hours. Cefepime for injection should be administered at the same time each day and following the completion of hemodialysis on hemodialysis days.

Reference(s)

National Institutes of Health, U.S. National Library of Medicine, DailyMed Database.
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