II. Background

  1. Semisynthetic, broad-spectrum, fourth-generation Cephalosporin
  2. Organisms Covered
    1. Broad spectrum Gram-positive and Gram-negative organisms (building on Third Generation Cephalosporin coverage)
    2. Beta-Lactamase resistant organisms
    3. Pseudomonas

III. Medications: Cefepime (Maxipime)

  1. Background
    1. Renal excretion
    2. Pregnancy Category B
    3. Safe in Lactation
  2. Adult (or child weight >40 kg)
    1. Low Dose (e.g. Mild to moderate severity Urinary Tract Infections)
      1. Dose: 0.5 to 1 g IM/IV every 12 hours
    2. Moderate Dose (e.g. Pneumonia)
      1. Dose: 1 to 2 g IV every 12 hours
    3. High Dose (e.g. severe Skin and Soft Tissue Infections, UTI, intraabdominal infections)
      1. Dose: 2 g IV every 12 hours
    4. Very High Dose (Febrile Neutropenia, Pseudomonas Osteochondritis, Meningitis)
      1. Dose: 2 g IV every 8 hours
  3. Child (weight <40 kg)
    1. Moderate Dose (e.g. Skin and Soft Tissue Infections, UTI, Pneumonia)
      1. Dose: 50 mg/kg IV every 12 hours (up to total daily dose of 4 grams/day)
    2. High Dose (e.g. Meningitis, Cystic Fibrosis, severe infections)
      1. Dose: 50 mg/kg IV every 8 hours (up to total daily dose of 6 grams/day)
  4. Adult Renal Dosing
    1. Creatinine Clearance 30 to 60 ml/min
      1. Dose: 500 to 2000 mg every 24 hours
      2. Febrile Neutropenia: 2 g every 12 hours
    2. Creatinine Clearance 11 to 29 ml/min
      1. Dose: 500 to 1000 mg every 24 hours
      2. Febrile Neutropenia: 2 g every 24 hours
    3. Creatinine Clearance <11 ml/min
      1. Dose: 250 to 500 mg every 24 hours
      2. Febrile Neutropenia: 1 g every 24 hours
    4. Hemodialysis
      1. Administer after Hemodialysis
      2. Dose: 1 g IV on day 1, then 500 mg every 24 hours
      3. Febrile Neutropenia: 1 g every 24 hours

V. References

  1. Hamilton (2020) Tarascon Pharmacopeia, Jones and Bartlett

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