II. 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

III. Mechanism

  1. Semisynthetic, broad-spectrum, fourth-generation Cephalosporin

IV. 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

V. Adverse Effects

  1. CNS Toxicity (including Seizures)
    1. Increased risk with renal dysfunction

VI. Safety

  1. Pregnancy Category B
  2. Safe in Lactation

VIII. References

  1. Hamilton (2020) Tarascon Pharmacopeia, Jones and Bartlett
  2. (2012) Presc Lett, Resource #280706, Comparison of Cephalosporins

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Ontology: cefepime (C0055003)

Definition (NCI_NCI-GLOSS) A drug used to treat infection. It belongs to the family of drugs called cephalosporin antibiotics.
Definition (NCI) A semisynthetic, broad-spectrum, fourth-generation cephalosporin with antibacterial activity. Cefepime binds to and inactivates penicillin-binding proteins (PBPs) located on the inner membrane of the bacterial cell wall. PBPs are enzymes involved in the terminal stages of assembling the bacterial cell wall and in reshaping the cell wall during growth and division. Inactivation of PBPs interferes with the cross-linkage of peptidoglycan chains necessary for bacterial cell wall strength and rigidity. This results in the weakening of the bacterial cell wall and causes cell lysis.
Concepts Antibiotic (T195) , Organic Chemical (T109)
MSH C043266
SnomedCT 96048006, 370371004
LNC LP17165-9, MTHU008443
English Pyrrolidinium, 1-((7-(((2-amino-4-thiazolyl)(methoxyimino)acetyl)amino)-2-carboxy-8-oxo-5-thia-1-azabicyclo(4.2.0)oct-2-en-3-yl)methyl)-1-methyl-, hydroxide, inner salt, (6R-(6alpha,7beta(Z)))-, cefepim, cefepime [Chemical/Ingredient], cefepime, CEFEPIME, Cefepime, Cefepime (substance), Cefepime product (product), Cefepime product
Spanish producto con cefepima (producto), cefepima (producto), producto con cefepima, cefepima (sustancia), cefepima