Cefiderocol Sulfate Tosylate Intravenous Infusion for Adults

Who can administer

• May be administered by registered competent doctor or nurse/midwife

Important information

• Risk of under-dosing if displacement value not accounted for see table 1
• Restricted to Microbiology or Infectious Diseases advice only (Red-light antimicrobial)
• If documented immediate, or severe delayed hypersensitivity REACTION to PENICILLIN or CEPHALOSPORIN: DO NOT GIVE THIS DRUG
• See under 'Dose' for adjustments required in renal impairment
• Note high salt content. A 2g dose is approximately 35% of WHO adult recommended maximum daily dietary intake. Refer to SPC for further information

Available preparations

Fetcroja 1g vial

Reconstitution

• Add 10mL of sodium chloride 0.9% or glucose 5% to each 1g vial, taken from the same bag
• Shake vial gently to dissolve powder and stand vial until surface foaming disappears (usually within 2 minutes)
• Dilute further prior to administration by returning the reconstituted vials to the bag- see dosing table below for further details

Infusion fluids

Sodium Chloride 0.9% or Glucose 5%

Methods of intravenous administration

Intermittent intravenous infusion (Table 1)

• Add required dose to infusion fluid (volume below) and administer over 3 hours

Cefiderocol dose	Number of 1g cefiderocol vials to be reconstituted	Volume to withdraw from reconstituted vial(s)	Total volume of cefiderocol solution required for further dilution.  Remove this volume for an infusion bag (minimum bag volume 100ml)  and replace with the drug solution
2g	2 vials	11.2 mL (entire contents) from both vials	22.4mL
1.5g	2 vials	11.2 mL (entire contents) from first vial AND 5.6 mL from second vial	16.8mL
1g	1 vial	11.2 mL (entire contents)	11.2mL
0.75g	1 vial	8.4 mL	8.4mL

• Do not use discoloured solutions or solutions with visible particulates

Dose in adults

Usual Dose (Table 2) ^{(ref 1)}

• Give 2g every 8 hours
• An increased frequency can be used in severe infection, based on renal function (see table below). However this must be done on a case by case basis in discussion with micro/ID
• Creatinine clearance must be calculated using Cockcroft and Gault equation rather than using eGFR

.

CrCl (mL/min)	Dose	Frequency
>120ml/min	2g	Every 6 hours
60 to 120	2g	Every 8 hours
30 to 60	1.5g	Every 8 hours
15 to 30	1g	Every 8 hours
<15	0.75g	Every 12 hours

Storage

Store in a refrigerator 2⁰ to 8⁰C

References

SPC April 2020

1: Sanford guide- checked 24/11/2011

Therapeutic classification

Antimicrobial