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