Extended Infusion Cefepime and Meropenem Tip Sheet
What: Cefepime orders are defaulting to 4 hour infusions; Meropenem will default to 3 hours.
Why:
• PD target for β-lactams: fT>MIC (time above MIC)
• Maximize the time-dependent bactericidal activity
• Target pathogens with high MIC (e.g. pseudomonas)
How:
1. Orders should default to a 30 min bolus first, then subsequent maintenance regimen
2. Maintenance to start based on order frequency
a. E.g. cefepime 1gm x1 (over 30’), then 1g q8h (over 4 hours) starting 8 hours after bolus
b. If pt already received a bolus dose, time subsequent doses accordingly (not necessary to re-bolus)
3. For limited access in those with concomitant vancomycin, consider compatibility issues
a. For meropenem, compatible at standard concentrations
i. Dose staggering not necessary
b. For cefepime, compatible for 1 hr, but not studied with extended infusions
i. Stagger doses: may refer to Appendix for time-tables for suggestions
ii. Change frequency from q8h to “TID” when applicable
iii. If unable to dose stagger, may revert to traditional infusion
4. Dosing regimens- same as before except infusion time change
a. Call MD for any renal dose changes
5. Opting out/exclusions
a. Limited line access
b. One-time doses for patients in the ED
c. Peri-op OR/PACU doses
d. Pediatrics
e. Ambulatory clinic