Revision of Cefepime from Oct 6, 2020

Dosing: Adult Antimicrobial Dosing, Non-dialysis

Short Infusion Dosing (PREFERRED)

Indication CrCl > 60 mL/min 30 - 60 mL/min 10 - 29 mL/min < 10 mL/min
Non-severe infections including cystitis 2 g IV q12h 2 g IV q24h 1 g IV q24h 500 mg IV q24h
Severe infections including febrile neutropenia, meningitis, Pseudomonas aeruginosa 2 g IV q8h 2 g IV q12h 2 g IV q24h 1 g IV q24h

Extended Infusion Dosing (if recommended by ID, ID pharmacy, or clinical pharmacy for select populations)

Indication CrCl > 60 mL/min 30 - 60 mL/min  < 30 mL/min
Loading Dose* 2 g x1 (over 30 minutes) 2 g x1 (over 30 minutes) Use short infusion
Maintenance: All Indications** 2 g IV q8h (over 4 hours) 2 g IV q12h (over 4 hours) Use short infusion

*Recommended to start maintenance dose 4 hours after loading dose 
**Extended infusion data in meningitis are limited and may require further discussion with ID/ASP providers 

Dosing: Antimicrobial Dosing in Intermittent & Continuous Hemodialysis

Indication

Intermittent Hemodialysis

Continuous Hemodialysis
All Indications

2 g IV x1 now and post-HD

Alternative dosing for patients not on stable hemodialysis schedule: 1 g x1 now, then qPM

1 g IV q8h*

*May infuse over 4 hours (extended infusion dosing) if recommended by ID, ID pharmacy, or clinical pharmacy for select populations. A loading dose (over 30 minutes) may be considered when initiating therapy in select patients. If a loading dose is given, start maintenance dose 4 hours after loading dose.

Dialysis Notes

Intermittent HD assumes high-flux hemodialysis. CRRT assumes CVVHD with ultrafiltration rate 2L/h and residual native GFR < 10 mL/min.  For detailed view of dialysis dosing and evidence, see Dosing in Hemodialysis document.

References: