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Am J Perinatol 2021; 38(07): 657-661
DOI: 10.1055/s-0039-3400312
Review Article

Cefepime Dosing in Neonates: What is the Evidence?

Danielle McDonald 
1   Department of Pharmacy, Cooper University Health Care, 1 Cooper Plaza, Camden, New Jersey
,
Pooja Shah
2   Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy at Rutgers University, The State University of NJ Piscataway, New Jersey
3   Department of Clinical and Pharmacy Services, Hackensack University Medical Center, Hackensack, New Jersey
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Abstract

Objective Recommended cefepime dosing strategies in neonates varies in commonly utilized dosing references with regard to dose and frequency. The objective of this review is to summarize and evaluate the available literature describing cefepime dosing in neonatal patients.

Study Design We performed a literature review in MEDLINE using the keyword cefepime. The search was limited to the English language, humans, and patients <2 months of age. We evaluated four pharmacokinetic studies and two studies describing the use of cefepime in clinical practice.

Results The available studies assessing cefepime serum concentrations in neonatal patients demonstrated maintenance of adequate pharmacokinetic parameters when utilizing a dosing frequency of every 12 hours, specifically for organisms with a minimum inhibitory concentration (MIC) ≤ 8 mg/L. In studies evaluating clinical outcomes of cefepime use in neonates, the most frequent adverse effects reported included seizures and hypophosphatemia. Microbiologic cure was demonstrated with a dosing regimen of 50 mg/kg per dose every 12 hours.

Conclusion Cefepime dosed 30 to 50 mg/kg per dose every 12 hours may be appropriate to achieve a concentration two to four times above an MIC ≤ 8 mg/L for at least 60% of the dosing interval in neonatal patients.

Keywords

cefepime - cephalosporins - infant - newborn - pharmacokinetics - antibacterial agents - drug monitoring - Pseudomonas


Publication History

Received: 31 July 2019

Accepted: 07 October 2019

Article published online:
27 November 2019

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