Cefepime; Uses, Dosage, Side Effects, Interactions

Cefepime

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

Cephalosporins are bactericidal and have the same mode of action as other beta-lactam antibiotics (such as penicillins). Cephalosporins disrupt the synthesis of the peptidoglycan layer of bacterial cell walls. The peptidoglycan layer is important for cell wall structural integrity, especially in Gram-positive organisms. The final transpeptidation step in the synthesis of the peptidoglycan is facilitated by transpeptidases known as penicillin-binding proteins (PBPs).
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.

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.

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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.
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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

More common

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Rare

Drug Interactions

Cefepime may interact with the following drugs, supplements, & may change the efficacy of drugs

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

 

Cefepime; Uses, Dosage, Side Effects, Interactions