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Click on icon to see table/diagram/image*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.
Impaired Hepatic Function: No adjustment is necessary for patients with impaired hepatic function.
Impaired Renal Function: In patients with impaired renal function (creatinine clearance ≦60 mL/min), the dose of Cefepime hydrochloride should be adjusted to compensate for the slower rate of renal elimination. The recommended initial dose of It should be the same as in patients with normal renal function. The recommended maintenance doses of Cefepime HCl in patients with renal insufficiency are presented in Table 6. When only serum creatinine is available, the following formula (Cockcroft and Gault equation) 3 may be used to estimate creatinine clearance. The serum creatinine should represent a steady state of renal function: (See Table 5.)
Click on icon to see table/diagram/imageRecommended Dosing Schedule for Cefepime in Adult Patients (Normal Renal Function, Renal Insufficiency, and Hemodialysis): (See Table 6.)
Click on icon to see table/diagram/imageIn patients undergoing continuous ambulatory peritoneal dialysis, Cefepime HCl may be administered at normally recommended doses at a dosage interval of every 48 hours. 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 HCl for hemodialysis patients is 1 g on Day 1 followed by 500 mg q24h for the treatment of all infections except febrile neutropenia, which is 1 g q24h. It should be administered at the same time each day and following the completion of hemodialysis on hemodialysis days. Data in pediatric patients with impaired renal function are not available; however, since cefepime pharmacokinetics are similar in adults and pediatric patient' changes in the dosing regimen proportional to those in adults are recommended for pediatric patients.
Administration: For Intravenous Infusion: Constitute the 1 g or 2 g piggyback (100 mL) bottle with 50 or 100 mL of a compatible IV fluid listed in the Compatibility and Stability subsection. Alternatively, constitute the 500 mg, 1 g, or 2 g vial, and add an appropriate quantity of the resulting solution to an IV container with one of the compatible IV fluids. The resulting solution should be administered over approximately in 30 minutes. Intermittent IV infusion with a Y-type administration set can be accomplished with compatible solutions. However, during infusion of a solution containing cefepime, it is desirable to discontinue the other solution.
For Intramuscular/Intravenous Administration: Cefepime hydrochloride should be constituted with one of the following diluents: Sterile Water for Injection, 0.9% Sodium Chloride, 5% Dextrose Injection: After reconstitution, solution is stable for 48 hours at temperatures not exceeding 30⁰C and 72 hours under refrigeration (2⁰C to 8⁰C);
0.5% or 1.0% Lidocaine Hydrochloride, or Sterile Bacteriostatic Water for Injection with Parabens or Benzyl Alcohol: Use immediately after reconstitution.
Preparation of Solutions of Cefepime HCl: (See Table 7.)
Click on icon to see table/diagram/imageSolutions of Cefepime HCl, like those of most beta-lactam antibiotics, should not be added to solutions of ampicillin at a concentration greater than 40 mg/mL, and should not be added to metronidazole, vancomycin, gentamicin, tobramycin, netilmicin sulfate or aminophylline because of potential interaction. However, if concurrent therapy with it is indicated, each of these antibiotics can be administered separately.
