Cefepime is 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.
Cefepime has an extended spectrum of activity against Gram-positive and Gram-negative bacteria, with greater activity against both Gram-negative and Gram-positive organisms than third-generation agents. Cefepime is usually reserved to treat severe nosocomial pneumonia, infections caused by multi-resistant microorganisms (e. g. Pseudomonas aeruginosa) and empirical treatment of febrile neutropenia.
Mechanism of Action
Indications
- Uncomplicated Urinary Tract Infections
- Pneumonia
- Skin and Structure Infection
- Skin or Soft Tissue Infection
- Urinary Tract Infection
- Bacterial Infections
- Complicated Intra-Abdominal Infections
- Complicated Urinary Tract Infections
- Meningitis, Bacterial
- Neutropenia, Febrile
- Pyelonephritis
- Severe Pneumonia
- Moderate Pneumonia
- Uncomplicated skin and subcutaneous tissue bacterial infections
- Febrile Neutropenia
- Bacteremia
- Intraabdominal Infection
- Kidney Infections
- Nosocomial Pneumonia
For the treatment of pneumonia (moderate to severe) caused by Streptococcus pneumoniae, including cases associated with concurrent bacteremia, Pseudomonas aeruginosa, Klebsiella pneumoniae, or Enterobacter species. Also for empiric treatment of febrile neutropenic patients and uncomplicated and complicated urinary tract infections (including pyelonephritis) caused by Escherichia coli or Klebsiella pneumoniae, when the infection is severe, or caused by Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis, when the infection is mild to moderate, including cases associated with concurrent bacteremia with these microorganisms. Also for the treatment of uncomplicated skin and skin structure infections caused by Staphylococcus aureus(methicillin-susceptible strains only) or Streptococcus pyogenes and complicated intra-abdominal infections (used in combination with metronidazole) caused by Escherichia coli, viridans group streptococci, Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterobacter species, or Bacteroides fragilis.
Contra-Indications
- History of severe hypersensitivity (e.g. anaphylactic reaction) to any other type of beta-lactam antibacterial agent (penicillins, monobactams, and carbapenems).
- Hemolytic anemia
- Liver problems
- Interstitial nephritis
- Subacute cutaneous lupus erythematosus
- Systemic lupus erythematosus
- Allergies cephalosporins & beta-lactamase
Dosage
Strengths: 500 mg; 1 g; 2 g; 1 g/50 mL
Adult Dose…………………………………………….
Intraabdominal Infection
- Complicated (used with metronidazole): 2 g IV every 12 hours for 7 to 10 days
Nosocomial Pneumonia
- 1 to 2 g IV every 8 to 12 hours
- Initial empiric treatment with broad-spectrum coverage according to the hospital’s and/or ICU’s antibiogram is recommended if multidrug-resistant organisms are suspected.
Pneumonia
- 1 to 2 g IV every 12 hours for 10 days
Pyelonephritis
- 2 g IV every 12 hours for 10 days
Skin or Soft Tissue Infection
- 2 g IV every 12 hours for 10 days
Urinary Tract Infection
- Mild to moderate; complicated or uncomplicated: 0.5 to 1 g IV or IM every 12 hours for 7 to 10 days
- IM administration is considered to be a more appropriate route for mild to moderate, uncomplicated or complicated urinary tract infections due to E coli.
- Severe; complicated or uncomplicated: 2 g IV every 12 hours for 10 days
Febrile Neutropenia
- 2 months up to 16 years and up to 40 kg: 50 mg/kg IV every 8 hours for 7 to 10 days depending on the nature and severity of the infection
- The maximum pediatric dose should not exceed the recommended dose for adults.
Intraabdominal Infection
- 2 months up to 16 years and up to 40 kg: 50 mg/kg IV every 12 hours for 7 to 10 days depending on the nature and severity of the infection
- The maximum pediatric dose should not exceed the recommended dose for adults.
Bacteremia
- 2 g IV every 8 hours
Febrile Neutropenia
- 2 g IV every 8 hours for 7 days or until neutropenia resolves
- The patient’s clinical status should be reassessed after 3 to 5 days of antimicrobial therapy.
Pediatric……………………………………………………
Pneumonia
- 2 months up to 16 years and up to 40 kg: 50 mg/kg IV every 12 hours for 7 to 10 days depending on the nature and severity of the infection
- The maximum pediatric dose should not exceed the recommended dose for adults.
Pyelonephritis
- 2 months up to 16 years and up to 40 kg: 50 mg/kg IV every 12 hours for 7 to 10 days depending on the nature and severity of the infection
- The maximum pediatric dose should not exceed the recommended dose for adults.
Skin and Structure Infection
- 2 months up to 16 years and up to 40 kg: 50 mg/kg IV every 12 hours for 7 to 10 days depending on the nature and severity of the infection
- The maximum pediatric dose should not exceed the recommended dose for adults.
Urinary Tract Infection
- 2 months up to 16 years and up to 40 kg: 50 mg/kg IV every 12 hours for 7 to 10 days depending on the nature and severity of the infection
- IM administration is considered to be a more appropriate route for mild to moderate, uncomplicated or complicated urinary tract infections due to E coli.
Side Effects
The most common
- allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
- leukopenia/leukemia
- hemolytic anemia
- serum sickness
- agranulocytosis
- pain, swelling, irritation where injected
- stomach upset
- sweating
- skin color change, mild diarrhea
- mild nausea
- loss of appetite
- vaginal discharge and itching
- swelling of feet or legs
- chest pain
- constipation
- cough
- diarrhea or loose stools
- difficulty with breathing
- dizziness
- heartburn
More common
- Abdominal or stomach pain, discomfort, or tenderness
- chills or fever
- difficulty with moving
- headache, severe and throbbing
- joint or back pain
- muscle aching or cramping
- muscle pains or stiffness
- chest pressure or squeezing pain in chest
- excessive sweating
- feeling of heaviness, pain, warmth and/or swelling in a leg or in the pelvis
- sudden tingling or coldness in an arm or leg
- sudden slow or difficult speech
- sudden drowsiness or need to sleep
- fast breathing
- sharp pain when taking a deep breath
- fast or slow heartbeat
- coughing up blood
- rust colored urine
- decreased amount of urine
Rare
- Anxiety
- change in vision
- seizures
- abnormal or fast heart rate
- tremors
- weight loss
- chest pain or tightness
- confusion
- cough
- Agitation
- arm, back, or jaw pain
- blurred vision
- chest pain or discomfort
- convulsions
- extra heartbeats
- fainting
- hallucinations
- a headache
- irritability
- lightheadedness
- mood or mental changes
- muscle pain or cramps
Drug Interactions
Cefepime may interact with the following drugs, supplements, & may change the efficacy of drugs
- aminoglycoside antibiotics (e.g., gentamicin, tobramycin)
- probenecid
- typhoid vaccine
- cholera vaccine,
- amoxicillin
- BCG vaccine
- Aspirin Low Strength (aspirin)
- Diphenhydramine
- Rosuvastatin
- Duloxetine
- Albuterol
- Topiramate
- Carbamazepine
- Vitamin D3 (cholecalciferol)
- Alprazolam
- Cetirizine
- Phenprocoumon
- Picosulfuric acid
- Warfarin
Pregnancy Catagory of Cefepime
FDA Pregnancy Category B
Pregnancy
There are limited data from the use of cefepime pregnant women. Studies in animals have shown no harmful effects on pregnancy, embryonal or fetal development, parturition or postnatal development. Cefepime should be prescribed to pregnant women only if the benefit outweighs the risk.
Lactation
This medication may pass into breast milk. If you are a breastfeeding mother and are taking cefepime it may affect your baby. Talk to your doctor about whether you should continue breastfeeding. It is not known if cefepime is safe for children under 6 months of age. There are no data on the effects of cefepime on fertility in humans. Reproductive studies in animals have shown no effects on fertility.
References
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