Clinical efficacy of cefepime in pneumonia caused by Pseudomonas aeruginosa.

Grant EM, Ambrose PG, Nicolau DP, Nightingale CH, Quintiliani R.

Justification for dosing cefepime twice daily in patients with a creatinine clearance (CrCl) > 60 ml/min or once daily in patients with a CrCl < 60 ml/min has been based on pharmacodynamic observations that it achieves sufficient (>50%) time above the MIC for susceptible organisms during the dose interval. Despite the pharmacodynamic support for this dosing schedule, there is a need for more clinical outcome data confirming that this dosing method is adequate, especially in patients with infections from difficult pathogens, like Pseudomonas aeruginosa. A retrospective study was performed in 58 non-neutropenic patients with culture positive Pseudomonas pneumonia who were treated with > 96 hours of cefepime dosed either Q12 or Q24 hours. Combination anti-pseudomonal therapy was allowed. Acceptable clinical response (cure/improvement) occurred in 71% and 82% of patients dosed Q24H and Q12H, respectively. In patients with Pseudomonas pneumonia with CrCl > 60 ml/min and CrCl < 60 ml/min, twice daily or once daily dosing of cefepime, respectively, results in acceptable clinical outcomes.

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