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Cefepime

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Cefepime, Maxipime

  • See Also
  1. Cephalosporin
  2. Fourth Generation Cephalosporin
  • Indications
  1. Conditions
    1. Complicated Urinary Tract Infection
    2. Intraabdominal infection
    3. Pseudomonas infections
    4. Pneumonia
    5. Meningitis
  2. Organisms Covered
    1. Broad spectrum Gram-positive and Gram-negative organisms (building on Third Generation Cephalosporin coverage)
    2. Beta-Lactamase resistant organisms
      1. More AmpB beta lactamase resistant than second and Third Generation Cephalosporins
      2. Better activity against Citrobacter and Enterobacter
    3. Pseudomonas coverage (similar to Ceftazidime)
    4. Although some anaerobic coverage, not active against Bacteroides fragilis
      1. Use with Metronidazole for intraabdominal infections
  • Mechanism
  1. Semisynthetic, broad-spectrum, fourth-generation Cephalosporin
  • Dosing
  1. Background
    1. Renal excretion
    2. Pregnancy Category B
    3. Safe in Lactation
  2. Adult (or child weight >40 kg)
    1. Low Dose (e.g. Mild to moderate severity Urinary Tract Infections)
      1. Dose: 0.5 to 1 g IM/IV every 12 hours
    2. Moderate Dose (e.g. Pneumonia)
      1. Dose: 1 to 2 g IV every 12 hours
    3. High Dose (e.g. severe Skin and Soft Tissue Infections, UTI, intraabdominal infections)
      1. Dose: 2 g IV every 12 hours
    4. Very High Dose (Febrile Neutropenia, Pseudomonas Osteochondritis, Meningitis)
      1. Dose: 2 g IV every 8 hours
  3. Child (weight <40 kg)
    1. Moderate Dose (e.g. Skin and Soft Tissue Infections, UTI, Pneumonia)
      1. Dose: 50 mg/kg IV every 12 hours (up to total daily dose of 4 grams/day)
    2. High Dose (e.g. Meningitis, Cystic Fibrosis, severe infections)
      1. Dose: 50 mg/kg IV every 8 hours (up to total daily dose of 6 grams/day)
  4. Adult Renal Dosing
    1. Creatinine Clearance 30 to 60 ml/min
      1. Dose: 500 to 2000 mg every 24 hours
      2. Febrile Neutropenia: 2 g every 12 hours
    2. Creatinine Clearance 11 to 29 ml/min
      1. Dose: 500 to 1000 mg every 24 hours
      2. Febrile Neutropenia: 2 g every 24 hours
    3. Creatinine Clearance <11 ml/min
      1. Dose: 250 to 500 mg every 24 hours
      2. Febrile Neutropenia: 1 g every 24 hours
    4. Hemodialysis
      1. Administer after Hemodialysis
      2. Dose: 1 g IV on day 1, then 500 mg every 24 hours
      3. Febrile Neutropenia: 1 g every 24 hours
  • Adverse Effects
  1. CNS Toxicity (including Seizures)
    1. Increased risk with renal dysfunction
  • Safety
  1. Pregnancy Category B
  2. Safe in Lactation
  • Resources
  1. Cefepime (Global RPH)
    1. https://globalrph.com/renal/cefepime/
  2. Cefepime (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=be5f8ca6-7232-423a-a2d5-cccb7abe7921
  • References
  1. Hamilton (2020) Tarascon Pharmacopeia, Jones and Bartlett
  2. (2012) Presc Lett, Resource #280706, Comparison of Cephalosporins