Intravenous (intravenously), intramuscularly (in / m). The dose and route of administration depend on the sensitivity of the pathogens, the severity of the infection, the condition of the function of the nights, and the general condition of the patient. Intravenous administration is recommended for patients with severe or life-threatening infections, especially when there is a risk of septic shock.
Adults and children with a body weight of more than 40 kg, with normal kidney function:
- Urinary tract infection of mild and moderate severity - 0.5-1 g IV or IM every 12 hours;
- infections of mild and moderate severity of other localizations - 1 g IV or IM every 12 h;
- severe infections - 2 g IV every 12 hours;
- very serious and life-threatening infections, including febrile neutropenia - 2 g IV every 8 h.
The usual duration of treatment is 7-10 days; severe infections may require longer treatment. In the treatment of febrile neutropenia, the usual duration of treatment is 7 days or until neutropenia disappears.
Prevention of infection during surgical operations: 60 minutes prior to the beginning of the surgical operation, intravenously infusion 2 g of the drug within 30 minutes.
Immediately after the end of the infusion, 0.5 g of metronidazole is administered intravenously. Due to pharmaceutical incompatibility, solutions of metronidazole and cefepime should not be mixed in a single vial of the infusion solution. Infusion system before the introduction of metronidazole should be washed. During prolonged (more than 12 hours) surgical operations 12 hours after the first dose, repeated administration of cefepime in the same dose is recommended with the subsequent administration of metronidazole.
Children from 2 months with a body weight of up to 40 kg:
- urinary tract infections, skin and soft tissue infections, pneumonia 50 mg / kg IV or IM twice a day for 10 days; in case of severe infections - every 8 hours;
- febrile neutropenia, septicemia, bacterial meningitis - 50 mg / kg every 8 hours for 7-10 days.
The dose for children should not exceed the maximum recommended dose for adults - 2 g IV every 8 hours. The experience of m / m use of the drug in children is limited.
Patients with impaired renal function: with renal failure requires a dose adjustment depending on the creatinine clearance. The dosage regimen depends on the degree of impaired renal function and the severity of the infection. With mild or moderate renal dysfunction, the initial dose of cefepime does not differ from the dose in patients with normal renal function.
Po known concentration of serum creatinine, calculate the clearance of creatinine according to the formula:
For men:
body weight (kg) x (140 - age in years)
Creatinine clearance = ____________________________________________
(ml / min) 72 x serum creatinine (mg / 100 ml)
For women: use the same formula, the result is multiplied by 0.85.
Supportive doses of cefepime depending on the creatinine clearance.
| Clearance creatinine (ml/ min) | Recommended maintenance doses |
| >60 | The usual dose, depending on the severity infection, adjustment is not required 0.5 g every 12 h 1 g every 12 h 2 g every 12 h 2 g every 8 h |
| 30-60 | 0.5 g every 24 hours | 1 g every 24 h | 2 g every 24 h | 2 g every 12 h |
| 11-29 | 0.5 g every 24 hours | 0.5 g every 24 hours | 1 g every 24 h | 2 g every 24 h |
| <11 | 0.25 g every 24 h | 0.25 g every 24 h | 0.5 g every 24 hours | 1 g every 24 h |
With continuous ambulatory peritoneal dialysis, the recommended maintenance dose is 0.5 g, 1 g or 2 g, depending on the severity of the infection, with an interval between administrations - 48 hours.
Patients on hemodialysis - 1 g in the first day of treatment, then 0.5 g every 24 hours for all infections, with the exception of febrile neutropenia, where the dose is 1 g every 24 hours. On hemodialysis days, the drug should be administered at the end of the hemodialysis procedure. If possible, the administration is carried out every day at the same time.
Children with impaired renal function a dose reduction or an increase in the interval between administrations is recommended, as indicated in the table above.
According to the known concentration of creatinine in the blood serum, calculate the clearance of creatinine according to the formula:
0.55 x height (cm)
Creatinine clearance = ----------------------------------------------- -----------
(ml / min / 1.73 m2) serum creatinine (mg / 100 mL)
or
0.52 x height (cm)
Creatinine clearance = ----------------------------------------------- -------------- - 3.6
(ml / min / 1.73 m2) serum creatinine (mg / 100 mL)
Patients with impaired hepatic function: correction of the dose is not required.
Preparation and administration of drug solutions
Intravenous Injection: 0.5 g or 1.0 g of the drug are dissolved, respectively, in 5 ml or in 10 ml of water for injection, 5% dextrose solution or 0.9% sodium chloride solution (volume of the resulting solution is 5.7 ml or 11.4 ml, approximate concentration of cefepime 90 mg / ml). Enter intravenously slowly for 3-5 minutes directly into the vein or through an intravenous system, together with a compatiblewe are M solution for intravenous administration.
Intravenous drip introduction: the prepared solution (see above) is transferred to a vial containing 50-100 ml of a compatible infusion solution. Enter through the system for IV infusions for at least 30 minutes. Drug solutions with a concentration of 1-40 mg / ml are compatible with infusion solutions: 0.9% solution of sodium chloride; 5% or 10% dextrose solution; 1/6 M sodium lactate solution, 5% dextrose solution and 0.9% sodium chloride; Ringer's lactate solution.
Intramuscular administration: 0.5 g or 1.0 g of the drug are dissolved, respectively, in 1.5 ml or in 3 ml of water for injection, 0.9% sodium chloride solution, bacteriostatic water for injection, 0.5% or 1% lidocaine solution solution, respectively, 2.2 ml or 4.4 ml,approximate concentration of cefepime 230 mg / ml). Receivedthe the solution is injected deeply intramuscularly into areas of the body with a pronounced muscular layer (upper-outer quadrant of the buttock or lateral surface of the thigh). It is recommended that an aspiration test be carried out to avoid undesirable introduction of the solution into the blood vessel. The dose up to 1 g can be introduced as a single dose injections. The maximum dose (2 g) should be given as two injections in different places. Since the administration of the drug is generally painless, in most cases it is not necessary to use a solution of lidocaine as a solvent. The prepared solutions of the preparation can be stored for 24 hours in the refrigerator at a temperature of (2-8) ° C or for 12 hours at room temperature (not above 25 ° C), without significant loss of activity. When stored, the powder and the prepared solution may darken, which does not affect the activity and quality of the preparation.