### Dosing CrCl > 80: 0.5 - 2 gm IV q 8 - 12 h. Extended infusion (a 4­ hour infusion of 2 g every 8 h) may increase survival in *[[Pseudomonas]]* *aeruginosa*. [^1] CrCl 80-50: 0.5 - 2 gm IV q 12 - 24 h. CrCl 50-10: 0.5 - 2 gm IV q 24 h. CrCl < 10: 250 mg - 500 mg IV q 25 h. Hemodialysis: 250 mg after dialysis. Peritoneal dialysis: 1 - 2 gm IV q 48 h. ### Important side effects Encephalopathy, myoclonus, and seizures when you don't alter the dose for age and CrCl. [^3] But who doesn't do that? Neutropenia, associated with  > "prolonged courses of [[cefepime]] (≥2 weeks), administered by rapid intravenous push." [^5] ### Important drug interactions ### Rants and Screeds ### Pearls Turns out that sensitive should be less than 8 ug/ml, not equal to 8 ug/ml. ### Treatment of choice ### Use for *[[Pseudomonas]]* and *[[Enterobacter]]* are often sensitive to this agent when resistant to all others. Also the *Enterobacteriaceae*. If the organism is an ESBL, DO NOT use [[cefepime]] even if susceptible. Won't work as well as carbapenems especially in diseases of high inoculum. [^4] Remember that sensitive in the lab does not always mean effective in the patient. [[Arthritis]], [[cellulitis]], neutropenic fever, intraabdominal infections, [[Meningitis]], [[osteomyelitis]], [[peritonitis]] - dialysis-related, [[pneumonia]], pyelonephritis, [[Cystitis]]### Don't use for I remain unenthusiastic about using this drug for *[[Staphylococcus]]*, despite it being a so-called 4th generation cephalosporin. It violates the MMHPVEAINASCSNOAT principal. [^2] ### Class Fourth-generation cephalosporin. ### Rationalization [^1]: Bauer KA, West JE, O'Brien JM, Goff DA. Extended-infusion [[cefepime]] reduces mortality in patients with [[Pseudomonas]] aeruginosa infections. Antimicrob Agents Chemother. 2013 Jul;57(7):2907-12. doi: 10.1128/AAC.02365-12. Epub 2013 Apr 9. PMID: 23571547; PMCID: PMC3697364. [^2]: My Mother Has Prosthetic Valve [[Endocarditis]] And Is Not A Surgical Candidate So Needs Optimal Antibiotic Therapy [^3]: My Mother Has Prosthetic Valve [[Endocarditis]] And Is Not A Surgical Candidate So Needs Optimal Antibiotic Therapy [^4]: Lee NY, Lee CC, Huang WH, Tsui KC, Hsueh PR, Ko WC. [[Cefepime]] therapy for monomicrobial bacteremia caused by [[cefepime]]-susceptible extended-spectrum beta-lactamase-producing Enterobacteriaceae: MIC matters. Clin Infect Dis. 2013 Feb;56(4):488-95. doi: 10.1093/cid/cis916. Epub 2012 Oct 22. PMID: 23090931. [^5]: Foong KS, Hsueh K, Bailey TC, Luong L, Iqbal A, Hoehner C, Connor L, Casabar E, Lane M, Burnett Y, Ritchie D, Krekel T, Newland H, Weilmuenster L, Heuring B, Durkin MJ, Hamad Y. A Cluster of [[Cefepime]]-induced Neutropenia During Outpatient Parenteral Antimicrobial Therapy. Clin Infect Dis. 2019 Jul 18;69(3):534-537. doi: 10.1093/cid/ciy1112. PMID: 30590400; PMCID: PMC6637276.