Cefepime Dosing for Ventilator-Associated Pneumonia

Standard Dosing Regimen

The Infectious Diseases Society of America recommends cefepime 2 g IV every 8 hours as the standard empiric dose for patients with normal renal function, with dose adjustments required based on creatinine clearance in patients with renal impairment 1
Cefepime 2 g IV every 8 hours is the recommended dose for empiric treatment of VAP in patients with normal renal function, and should be used as part of combination therapy when empiric coverage for multidrug-resistant pathogens is indicated 1, 2

The Infectious Diseases Society of America recommends that cefepime should NOT be used as monotherapy for empiric VAP treatment, and must be combined with an agent from a different class for empiric double gram-negative coverage in high-risk patients 1, 3
MRSA coverage should be added if risk factors are present, and aminoglycosides should never be used as the sole antipseudomonal agent 1, 3
De-escalation to monotherapy is recommended once susceptibilities are known, unless the patient has septic shock 3

Alternative antipseudomonal beta-lactams include piperacillin-tazobactam 4.5 g IV every 6 hours, ceftazidime 2 g IV every 8 hours, meropenem 1 g IV every 8 hours, and imipenem 500 mg IV every 6 hours 1