Cefepime

Intravenous
Intramuscular
Class
Antibiotics
Subclass
Fourth-generation cephalosporins
Substance name
Cefepime hydrochloride
Brand names
Maxipime®
Common formulations
Powder for parenteral solution
Dosage and administration
Adults patients
Treatment
Intra-abdominal infections • Complicated
•
2 g IV q12h for 7 to 10 days
Pneumonia • Moderate-to-severe
•
1-2 g IV q8-12h for 10 days
SSTIs • Moderate-to-Severe, uncomplicated
•
2 g IV q12h for 10 days
UTIs • Severe
•
2 g IV q12h for 10 days
Bacterial meningitis • Off-label
•
6 g IV daily, in 3 divided doses
Catheter-associated infections • Off-label
•
2 g IV q8h
Hospital-acquired pneumonia • Off-label
•
2 g IV q8h for 7 days
Native vertebral osteomyelitis • Off-label
•
2 g IV q8-12h
Osteomyelitis • Off-label
•
2 g IV q8-12h
Adjunctive treatment
Adjunctive treatment for febrile neutropenia • Empiric therapy
•
2 g IV q8h for 7 days or until resolution of neutropenia
Indications for use
Labeled indications
Adults
•
Treatment of intra-abdominal infections (complicated)
•
Treatment of pneumonia (moderate-to-severe)
•
Treatment of SSTIs (moderate-to-Severe, uncomplicated)
•
Treatment of UTIs (mild-to-moderate)
•
Treatment of UTIs (severe)
•
Adjunctive treatment for febrile neutropenia (empiric therapy)
Off-label indications
Adults
•
Treatment of bacterial meningitis
•
Treatment of catheter-associated infections
•
Treatment of hospital-acquired pneumonia
•
Treatment of native vertebral osteomyelitis
•
Treatment of osteomyelitis
Safety risks
Contraindications
Hypersensitivity to cefepime hydrochloride or any of its components or other cephalosporins, penicillins or other β-lactam antibacterial drugs
Warnings and precautions
Antimicrobial resistance
•
Maintain a high level of suspicion, as the use of cefepime in the absence of a proven or strongly suspected bacterial infection increases the risk of developing drug-resistant bacteria.
C. difficile infection
•
Maintain a high level of suspicion, as Clostridium difficile associated diarrhea is reported with use of cefepime hydrochloride, and may present as mild diarrhea to more severe colitis.
Increased urine glucose
•
Maintain a high level of suspicion, as cefepime has been reported to cause false-positive results for urine glucose tests using copper reduction.
Neurotoxicity
•
Maintain a high level of suspicion, as cefepime has been associated with an increased risk of neurotoxicity, including encephalopathy, aphasia, myoclonus, seizures, and nonconvulsive status epilepticus, mostly occurring in patients with renal impairment who did not receive appropriate dosage adjustment.
Positive direct Coombs test
•
Maintain a high level of suspicion, as positive direct Coombs tests with or without hemolysis have been reported during treatment with cefepime.
Specific populations
Renal impairment
CrCl > 60 mL/min
•
Use acceptable. No dose adjustment required. Monitor prothrombin time.
CrCl 30-60 mL/min
•
Monitor prothrombin time. Reduce the dose to 500 mg daily for indications requiring usual doses of 500 mg BID. Reduce the dose to 1,000 mg daily for indications requiring usual doses of 1,000 mg BID. Reduce the dose to 2,000 mg daily for indications requiring usual doses of 2,000 mg BID. Reduce the dose to 2,000 mg BID for indications requiring usual doses of 2,000 mg TID.
CrCl 11-29 mL/min
•
Monitor prothrombin time. Reduce the dose to 500 mg daily for indications requiring usual doses of 500 mg BID. Reduce the dose to 500 mg daily for indications requiring usual doses of 1,000 mg BID. Reduce the dose to 1,000 mg daily for indications requiring usual doses of 2,000 mg BID. Reduce the dose to 2,000 mg daily for indications requiring usual doses of 2,000 mg TID.
CrCl ≤ 10 mL/min
•
Monitor prothrombin time. Reduce the dose to 250 mg daily for indications requiring usual doses of 500-1,000 mg BID. Reduce the dose to 500 mg daily for indications requiring usual doses of 2,000 mg BID. Reduce the dose to 1,000 mg daily for indications requiring usual doses of 2,000 mg TID.
Renal replacement therapy
Continuous renal replacement
•
Administer 1,000 mg TID or 2,000 mg BID depending on the therapeutic modality and flow rates.
Intermittent hemodialysis
•
Administer the dose after dialysis session. Reduce the dose to 500 mg daily (with an initial dose of 1,000 mg on day 1) for indications requiring usual doses of 500-2,000 mg BID. Reduce the dose to 1,000 mg daily for indications requiring usual doses of 2,000 mg TID.
Peritoneal dialysis
•
Administer the usual dose based on the indication at an interval of q48h.
Hepatic impairment
Any severity
•
Use acceptable. No dose adjustment required.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: B1
•
Use only if benefits outweigh potential risks. Evidence of fetal harm in animals. Cephalosporins are generally considered safe for use in pregnancy. Cefepime is considered as a first-line option for pyelonephritis in pregnancy.
Breastfeeding
Acceptable for use during breastfeeding.
Very low levels in breastfed infants (< 5%).
Adverse reactions
Very common > 10%
•
⊕ direct Coombs test
Common 1-10%
•
↓ serum phosphate, ↑ BUN, ↑ serum ALT, ↑ serum AST, phlebitis, ↑PT, ↑PTT, diarrhea, fever, generalized pruritus, headache, nausea, skin rash, vomiting
Uncommon < 1%
•
↓ WBC count, ↓ blood neutrophil count, ↓ hematocrit, ↓ platelet count, ↓ serum calcium, ↑ serum ALP, ↑ serum TBIL, ↑ serum calcium, ↑ serum creatinine, ↑ serum phosphate, oral candidiasis, urticaria, vaginitis
Unknown frequency
•
AKI, agranulocytosis, allergic reactions, anaphylaxis, aphasia, aplastic anemia, Clostridioides difficile infection, cholestasis, colitis, death, encephalopathy, erythema multiforme, hemolytic anemia, myoclonus, blurred vision, injection site pain, injection site reactions, lightheadedness, seizure, status epilepticus, Stevens-Johnson syndrome
Interactions
Drug(s)
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