Cefiderocol
General Information
Do NOT use if patient has a history of severe penicillin allergy. If in doubt, discuss with Micro/ID.
Restricted formulary antimicrobial: For details see OUH netFormulary
AWaRe antibiotic classification: 'Reserve'. All indications to be discussed with Micro/ID.
Dosing including renal and hepatic dosing
Renal impairment
|
Creatinine clearance (ml/min) |
cefiderocol IV dose |
|
Augmented renal clearance with CrCL of 120 mL/min or more |
2g QDS * |
|
60-119 |
2g TDS |
|
30-59 |
1.5g TDS |
|
15-29 |
1g TDS |
|
Less than 15 |
750mg BD |
|
Patient with intermittent haemodialysis |
750mg BD Administer cefiderocol at the earliest possible time after completion of haemodialysis on haemodialysis days. |
Note: dose ranges use creatinine clearance, rather than eGFR.
* QDS dosing can contribute a large sodium load if the dose is administered in sodium chloride 0.9% infusion fluid. Consider choice of infusion fluid when dosing QDS. See additional information below.
Hepatic impairment
No dose adjustment necessary.
Pregnancy and breastfeeding
Pregnancy
Discuss with pharmacy.
Breastfeeding
Discuss with pharmacy.
Additional information
Sodium content:
- Each 1 g vial contains 7.64 mmol of sodium (approximately 176 mg).
- Each 2 g dose of cefiderocol, when infused in 100 mL of 0.9% sodium chloride injection, contains 30.67 mmol (705 mg) of sodium.
- The daily sodium content for a patient on 2 g cefiderocol TDS administered in 100ml sodium chloride 0.9% is 2.1 g, just greater than the WHO recommend daily maximum of 2 g sodium for an adult.
- For patients with augmented clearance who may require 2g cefiderocol QDS, consider infusing with glucose 5%.
- Consider monitoring electrolytes e.g. in patients with congestive heart failure, renal impairment, liver disease or those on salt restricted diets
Monitor renal function regularly.
Cefiderocol may result in false-positive results in urine dipstick tests (urine protein, ketones, or occult blood). Alternative methods of testing should be used by the clinical laboratories to confirm positive tests.
References
- Summary of Product Characteristics (SPC) for Fetcroja 1 g powder. Last updated 23/4/20. Accessed via www.medicines.org.uk on 6/11/21
- BNF online accessed via www.medicinescomplete.com on 6/11/21