The U.S. Food and Drug Administration (FDA) recently issued an alert on the potential risk of non-convulsive status epilepticus associated with the use of cefepime, a broad spectrum fourth generation cephalosporin.

Cefepime: FDA Drug Safety Communication on Non-Convulsive Status Epilepticus Risk

August 1, 2012

Manufacturer's Recommended Dosing Schedule Based on Indication
Creatinine Clearance (mL/min)	UTI^a	UTI^a, Pneumonia^b	Pneumonia^b, UTI^c, Intra-abdominal^d, SSSI^e	Febrile Neutropenia^f
> 60	500 mg IV Q 12 h	1 g IV Q 12h	2 g IV Q 12h	2 g IV Q 8h
30-60	500 mg IV Q 24h	1 g IV Q 24h	2 g IV Q 24h	2 g IV Q 12h
11-29	500 mg IV Q 24h	500 mg IV Q 24h	1 g IV Q 24h	2 g IV Q 24h
<11	250 mg IV Q 24h	250 mg IV Q 24h	500 mg IV Q 24h	1 g IV Q 24h
CAPD	500 mg IV Q 48h	1 g IV Q 48h	2 g IV Q 48h	2 g IV Q 48h
Hemodialysis (post-dialysis on dialysis day)	1 g on day 1, then 500 mg IV Q 24h	1 g on day 1, then 500 mg IV Q 24h	1 g on day 1, then 500 mg IV Q 24h	1 g IV Q 24h

Patient [Reference]	Age in Years, Gender	Indication	Dosing Regimen	Renal Function	Confounding Factors
1 [5]	54, M	Febrile neutropenia	1 g IV Q 24h	CrCl – 12-27 mL/min	None
2 [5]	60, F	Febrile neutropenia	1 g IV Q 24h	CrCl – 13-15 mL/min	None
3 [6]	79, F	Urinary tract infection	2 g IV Q 12h	CrCl – 45 mL/min	None
4 [7]	76, F	Gangrenous pyoderma	2 g IV Q 8h	SCr – 3 mg/dL	Chronic alcoholism
5 [7]	38, F	Febrile neutropenia	2 g IV Q 8h	SCr – 3.2 mg/dL	None
6 [7]	43, M	Abdominal sepsis	2 g IV Q 12h	SCr – 1.7 mg/dL	Chronic alcoholism
7 [8]	74, F	Pneumonia	4 g IV/day	SCr – 10.1 mg/dL	Prior ceftriaxone use
8 [9]	15, M	Pneumonia	12.5 mg/kg/day	Peritoneal dialysis	None
9 [10]	66, F	Febrile neutropenia	2 g IV Q 8h	CrCl – 30 mL/min	None
10 [11]	65, M	Febrile neutropenia	2 g IV Q 8h	SCr – 2.8 mg/dL	Prior cloxacillin use
11 [12]	82, M	Pneumonia	1 g IV Q 24h	Hemodialysis	None
12 [13]	65, M	Gram-negative bacteremia	2 g/day	SCr – 12 mg/dL	None
13 [13]	73, F	Knee prosthesis infection	2 g/day	SCr – 17.7 mg/dL	None
14 [14]	69, F	Pneumonia	2 g/day	Peritoneal dialysis	None
15 [15]	79, M	Pneumonia	1 g/day	SCr – 4.5 mg/dL	Erythropoietin use
16 [15]	67, F	Pneumonia	2 g IV Q 6h	SCr – 3.5 mg/dL	None
17 [15]	64, F	Pneumonia	1 g/day	SCr – 5 mg/dL	Cyclosporine use
18 [15]	54, M	Immunocompromised	2 g/day	SCr- 3.2 mg/dL	Ciprofloxacin use
19 [15]	86, M	Osteomyelitis	2 g IV Q 12h	SCr – 5.1 mg/dL	Ganciclovir use
20 [15]	79, F	Pneumonia	2 g IV Q 12h	SCr – 5.2 mg/dL	None
21 [16]	NR, NR	Unable to translate	Not reported	Not reported	Unable to translate
22 [16]	NR, NR	Unable to translate	Not reported	Not reported	Unable to translate
23 [17]	44, M	Pneumonia	2 g/day	Hemodialysis	Ciprofloxacin, Tacrolimus use
24 [17]	28, F	Urinary tract infection	1 g IV Q 12h	SCr – 1.8 mg/dL	Prior seizures, ceftazidime
25 [18]	15, F	Gram-negative bacteremia	1 g IV Q 12h	Hemodialysis	None
26 [19]	70, F	Febrile neutropenia	2 g IV Q 24h	CrCl – 14-17 mL/min	Prior seizure