Cefepime dosing

Empirical therapy for postoperative infections in neurosurgical patients (including patients with CSF shunts) should include vancomycin in combination with either cefepime, ceftazidime, or meropenem. Linezolid has been reported to reach adequate CSF concentrations and resolve cases of meningitis refractory to vancomycin.35 However, data with linezolid are limited. The addition of rifampin should be considered for treatment of shunt infections. When culture and sensitivity data are available, pathogen-directed antibiotic therapy should be administered. Removal of infected devices is desirable aggressive antibiotic therapy (including high-dose intravenous antibiotic therapy plus intraventricular vancomycin and/or tobramycin) may be effective for patients in whom hardware removal is not possible.36... 

Dual therapy with Cefepime, ceftazidime, imipenem, meropenem, Gentamicin or tobramycin 2 mg/kg loading dose... 

Renal function impairment- In patients with impaired renal function (Ccr less than 60 mL/min), adjust the dose of cefepime to compensate for the slower rate of renal elimination. The recommended initial dose should be the same as in patients with normal renal function. 

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. Give a repeat dose, equivalent to the initial dose, at the completion of each dialysis session. 

In patients undergoing continuous ambulatory peritoneal dialysis, administer cefepime at normal recommended doses at a dosage interval of every 48 hours. 

Renal impairment Data in pediatric patients with impaired renal function are not available however, because cefepime pharmacokinetics are similar in adult and pediatric patients, changes in dosing regimen similar to those in adults are recommended for pediatric patients. 

The symptoms started 1-5 days after the first dose and varied from nightmares, anxiety, agitation, and visual and auditory hallucinations to coma and seizures. After withdrawal of cefepime, they recovered within 1-5 days. The causality between their neuropsychiatric symptoms and cefepime was considered as probable (WHO criteria) because of the temporal relation, lack of other causal neurological explanations, and positive rechallenge in five patients. 

In the first case the dose was inappropriate for the degree of renal impairment and in the second case the dose was inappropriate for the patient s body weight. The authors underlined the importance of giving cefepime with great care, especially to patients with renal impairment and low body weight. 

Five patients developed severe symptoms after receiving cefepime (31). The patients, three men and two women, aged 16-75 years, received 2 g/day (n — 3) A g/day n = 1) or 9 g/day n — 1). The symptoms started 12-16 days after the start of therapy. In all cases, the initial neurological symptoms (disorientation, confusion, and reduced consciousness) were progressive and were attributed to the infection. Facial or multifocal myoclonic movements occurred subsequently and were rapidly followed by convulsive or non-convulsive status epilepticus. The dose of cefipime had not been adjusted for renal function in any of the patients. Cefepime serum concentrations were measured in three cases, and were 72, 73, and 134 gg/ml. All the patients underwent hemodialysis, and the serum concentrations of cefepime fell to 4.3, 21, and 25 gg/ml respectively. In the other two patients, the serum concentrations after dialysis were 14 and 54 gg/ml, suggesting high concentrations before dialysis. There was complete recovery in four of the patients. One, a 73-year-old woman, died of multiorgan failure with refractory status epilepticus and coma. The authors referred to four... 

It has long been known that intramuscular procaine penicillin can cause some peculiar psychological adverse reactions, and that other penicillin derivatives, such as amoxicillin, can cause psychiatric reactions, such as hallucinations (SEDA-21, 259). In a report from the Netherlands, neuropsychiatric symptoms occurred in six patients who received cefepime for febrile neutropenia (33). The patients, two men and four women, aged 32-75 years, received 6 g/day (n = 5) or 3 g/day (n = 1). The symptoms started 1-5 days after the first dose and varied from nightmares, anxiety, agitation, and visual and auditory hallucinations to coma and seizures. After withdrawal of cefepime, they recovered within 1-5 days. The causality between their neuropsychiatric symptoms and cefepime was considered as probable (WHO criteria) because of the temporal relation, lack of other causal neurological explanations, and positive rechaUenge in five patients. 

VirtnaUy all cephalosporins can cause neutropenia and agrannlocytosis (73). This has been associated with cefa-pirin (74), cefepime (75), cefmenoxime (76), cefmetazole (77), ceftriaxone (78-81), moxalactam (82), and others. All of these cases were seen after high cumulative doses given in one treatment course. In one series, cefapirin-induced nentropenia occnrred in five of 19 patients who took a total of 90 g or more, but not in 113 patients who took smaller cnmnlative doses (74). It has not been settled whether toxic mechanisms, immunological mechanisms, or both are involved. 

A 58-year-old woman with end-stage renal insufficiency secondary to diabetic nephropathy developed abdominal wall cellulitis 4 days after insertion of a peritoneal dialysis catheter. She was given vancomycin, cefepime, and metronidazole in reduced doses (doses not stated) and 2 days later developed dysarthria, an intention tremor, dysmetria, and dysdiadochokinesia. Routine biochemical tests were unchanged and a CT scan of the brain was unremarkable, but an MRI scan showed cerebral and cerebellar atrophy with multifocal ischemic glial lesions. Metronidazole was withdrawn and 2 days later her symptoms and signs had completely resolved. 

Cefepime 1-2 g iV q.Shr S5% q.S-12hr q.12hr q.24hr Group toxicity 1 g after dialysis Dose for GFR < 10 ml/min Not recommended... 

HS is an 80-year-old man with a postoperative infection. You are asked to write an order for crfepime. HS weighs 72 kg and has a serum Cr level of 3 mg/dL. The hospital dosing guidelines for cefepime are given in Table 1-1. 

Table 1-1 Dosing guidelines for cefepime based on renal function...

That would indicate that the recommended dose of cefepime is... 

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