Table 1.
Continuous infusion cephalosporins dosing recommendations.
| Agent | Dosing Recommendation for CI | Storage/Stability | Notes/Special Populations * | MIC90 of Relevant Pathogens (mcg/mL) |
|---|---|---|---|---|
| Cefazolin (CFZ) [7,8,9] | CFZ 2 g IV LD followed by CI of 60–80 mg/kg/day Maximum daily dose: 12 g |
Reconstituted solutions are stable for 1 day at room temperature and for 10 days under refrigeration. Protect powders and reconstituted solutions from light. Parenteral admixtures are stable for 48 h at room temperature and 14 days when refrigerated. |
Doses may be adjusted for body weight. Consider therapeutic drug monitoring to target serum concentrations of 40–70 mg/L. |
MSSA: <2 E. coli: 1.6 K. pneumoniae: 4 Enterobacter spp.: >32 H. influenzae: 16 Streptococcus spp.: ≤2 |
| Cefuroxime (CXM) [10,11,12,13,14,15,16,17] | CXM 1.5 g IV LD followed by CI of 3 g/24 h Maximum daily dose: 4.5 g |
Reconstituted solution with NS or D5W is stable for 24 h at room temperature, 7 days when refrigerated, or 26 weeks when frozen. Store intact vials at 15–30 °C (59–86 °F) and protect them from light. |
Dose adjustments should be considered in patients with renal impairment. | MSSA: 2 E. coli: 8 K. pneumoniae: >16 Enterobacter spp.: >16 H. influenzae: 4 S. pneumoniae: 8 Viridans streptococci: 4 Beta-hemolytic streptococci: 0.25 |
| Ceftriaxone (CRO) [18,19,20,21,22,23,24] | CRO 500 mg IV LD followed by 2 g/24 h Maximum daily dose: 6 g |
Thawed premixed solutions (manufacturer premixed) are stable for 3 days at 25 °C (77 °F) or for 21 days at 5 °C (41 °F). Reconstituted solution (100 mg/mL) with NS, D5W, or SWFI is stable for 2 days at room temperature or 10 days when refrigerated. Prior to reconstitution, store powder for injection at ≤25 °C (≤77 °F) and protect from light. |
MSSA: 4 E. coli: 4–8 K. pneumoniae: >8 S. pneumoniae: 1 Viridans streptococci: 1 Beta-hemolytic streptococci: 0.06–0.12 N. meningitidis: <0.0002 H. influenzae: ≤0.06 M. catarrhalis: 0.5 P. mirabilis: ≤0.25 |
|
| Ceftazidime (CAZ) [25,26,27,28,29,30] | CAZ 2 g IV LD followed by 6 g/24 h Maximum daily dose: 12 g |
Thawed solution in NS in a Viaflex is stable for 24 h at room temperature and for 7 days after refrigeration. If reconstituted in NS D5W, D5NS, LR, or D10W, it is stable for 24 h at room temperature and for 7 days when refrigerated. Reconstituted and further diluted solutions are stable for 24 weeks when frozen at −20 °C (−4 °F). Vials should be stored at 20–25 °C (68–77 °F) and protected from light. |
E. coli: ≤2 Enterobacter spp.: >16 Klebsiella spp.: ≤2 H. influenzae: ≤0.25 M. catarrhalis: 0.5 P. mirabilis: ≤0.12 P. aeruginosa: 16 Serratia spp.: 0.25 S. maltophilia: >16 |
|
| Ceftazidime/avibactam (CAZ/AVI) [18,31,32,33,34,35] | CAZ/AVI 2.5 g IV LD followed by CAZ/AVI 10 g/24 h Maximum daily dose: 15 g |
Reconstitute vial with 10 mL of NS, D5W, SWFI, or other compatible solution. Mix and further dilute to a concentration of 8–40 mg/mL CAZ and 2–10 mg/mL AVI. Store intact vials at 25 °C. After reconstitution, transfer to infusion bag within 30 min for further dilution. Admixed solutions (up to dextrose 2.5% and sodium chloride 0.45%) are stable up to 12 h at room temperature and 24 h at 2 °C to 8 °C. |
Citrobacter spp.: 0.12 Enterobacter spp.: 0.5 E. coli: 0.12 E. coli (ESBL phenotype): 0.25 H. influenzae: 0.03 K. pneumoniae: 0.5 K. pneumoniae (ESBL phenotype): 1 K. pneumoniae (meropenem NS): 2 M. catarrhalis: 0.12 P. mirabilis: 0.06 P. aeruginosa: 4 P. aeruginosa (meropenem NS): 16 P. aeruginosa (XDR): 32 |
|
| Cefotaxime (CTX) [11,25,36,37,38,39,40,41,42,43,44,45,46] | CTX 1 g IV LD followed by 2–4 g/24 h Maximum daily dose: 8 g |
Reconstituted solution stable for 12–24 h at room temperature, 7–10 days when refrigerated, and 13 weeks when frozen. IV infusions in NS or D5W solution are stable for 24 h at room temperature, 5 days when refrigerated, or 13 weeks when frozen in Viaflex plastic containers. Thawed solutions of frozen mixed bags are stable for 24 h at room temperature or 10 days when refrigerated. Store vials in temperatures below 30 °C (86°) and protect from light. |
A dosing range of 0.5 to 2 g in 12 h intervals may be suitable for non-immunocompromised patients without CNS infections. | MSSA: 4 S. pneumoniae: 1 Viridans streptococci: 1 Beta-hemolytic streptococci: ≤0.06 Citrobacter spp.: 128 Enterobacter spp.: 256 E. coli: ≤1 K. pneumoniae: ≤1 N. meningitidis: 0.007 H. influenzae: ≤0.015 M. catarrhalis: 1 P. mirabilis: ≤1 Serratia spp.: 128 |
| Cefepime (FEP) [25,27,42,43,47,48] | FEP 2 g IV LD followed by 4–6 g/24 h Maximum daily dose: 6 g (note, 8 g has been used in patients with augmented clearance) |
After reconstitution with NS or D5W, it is stable for 24 h at room temperature or 7 days when refrigerated. Intact vials must be stored at 20–25 °C (68–77 °F) and protected from light. |
Dose adjustments should be considered in patients with renal impairment and those with augmented renal clearance (potentially up to 8 g). | MSSA: 4 S. pneumoniae: 1 Beta-hemolytic streptococci: ≤0.12 Viridans streptococci: ≤0.12 Citrobacter spp.: ≤0.25 Enterobacter spp: ≤1 E. coli: ≤0.25 H. influenzae: ≤0.25 Klebsiella spp.: ≤0.25 M. morganii: ≤0.25 P. mirabilis: ≤1 P. aeruginosa: 16 Serratia spp.: ≤0.25 |
| Ceftaroline (CPT) [12,18,19,21,49,50] |
CPT 600 mg IV LD followed by 1.2 g/24 h Maximum daily dose: 1.8 g |
After reconstitution in 1/2NS, D5W, LR, or NS, it must be used within 6 h when stored at room temperature or within 24 h if refrigerated at 2–8 °C (36–46 °F). Vials must be stored at 25 °C (77 °F). |
Dose adjustments should be considered in patients with renal impairment. | MSSA: 0.25 MRSA: 1 S. pneumoniae: 0.12 Viridans streptococci: 0.12 Beta-hemolytic Streptococci: ≤0.015 E. coli: 0.25 K. pneumoniae: 8 P. mirabilis: 0.25 Serratia spp.: 2 |
| Ceftobiprole (BPR) [20,51,52,53,54] | BPR 500 mg LD followed by 2 g/24 h Maximum daily dose: 3 g |
After reconstitution in NS, may store for 4 h at 25 °C (77 °F) or 24 h at 2 °C to 8 °C (36–46 °F). After reconstitution in D5W, may store for 6 h at 25 °C (77 °F) or 94 h at 2 °C to 8 °C (36–46 °F). Reconstituted solution should be protected from light. Vials must be stored at 2–8 °C (36–46 °F) and protected from light. Reconstituted solutions may store for ≤1 h at room temperature and ≤24 h refrigerated prior to further dilution in an infusion bag. |
Dose adjustments should be considered in patients with renal impairment. | MSSA: 0.5 MRSA: 2 S. pneumoniae: ≤0.015 Viridans streptococci 0.25 Beta hemolytic Streptococci ≤ 0.06 E. coli: 0.06 K. pneumoniae 0.06 P. mirabilis: ≤0.06 P. aeruginosa: 16 Serratia spp.: 8 |
| Ceftolozane/tazobactam (C/T) [55,56,57,58,59] | C/T 3 g IV LD followed by 4.5 g–6 g/24 h Maximum daily dose: 9 g |
Diluted solutions can be stored for 24 h at room temperature or for 7 days at 2–8 °C (36–46 °F). Vials must be stored at 2–8 °C (36–46 °F) and protected from light. Reconstituted solutions can be held for 1 h prior to placement and further dilution into an infusion bag. |
S. aureus: 32 S. pneumoniae: 0.125–16 Citrobacter spp.: 8 Enterobacter spp.: 8 E. coli: 0.5 E. coli (ESBL phenotype): 4 K. pneumoniae: >32 K. pneumoniae (ESBL phenotype): >32 P. mirabilis: 0.5 P. aeruginosa: >32 P. aeruginosa (MDRS): >32 P. aeruginosa (XDR): >32 Serratia spp.: 1 |
|
| Cefoxitin (FOX) [7,60,61,62,63] | FOX 2 g IV LD followed by either 3 g/24 h (if ≤80 kg) or 6 g/24 h (if >80 kg) Maximum daily dose: 8 g |
Prior to reconstitution, store at 2–25 °C (36–77 °F). Reconstituted solution in SWFI, BWFI, NS, or D5W is stable for 6 h at room temperature or for 7 days when refrigerated. | ≥6 g/day is likely required for most rapidly growing mycobacterial organisms, especially in deep-seated infections. | MSSA: 4 Enterobacter spp.: 256 E. coli: 8 K. pneumoniae: 16 H. influenzae: 4 M. morganii: 32 P. mirabilis: 4 Serratia spp.: 64 |
* A pharmacist should evaluate the safety of compatibility and determine if there is considerable advantage to mixing agents or administering concomitant IV medications through the same line. LD: loading dose; h: hour; CNS: central nervous system; NS: normal saline; D5W: dextrose 5% in water; SWFI: sterile water for injection; BWFI: bacteriostatic water for injection; CI: continuous infusion; ESBL: Extended-spectrum beta-lactamase; NS: non-susceptible.