Cefepime

General

• Type: Fourth generation cephalosporin
• Dosage Forms: IV, IM
• Common Trade Names: Maxipime

Adult Dosing

Bacterial Infections

• 1-2 g IV q12H (Max: 6 g/24h; dose, duration varies with infection type, severity)

Febrile Neutropenia

• 2g IV q8H

UTI, mild-moderate

• 0.5-1g IV/IM q12H x7-10 days (IM only for UTI due to E. coli)

UTI, severe

• 2g IV q12H x10 days

Renal dosing

• Febrile Neutropenia: CrCl 30-60: 2 g q12H; CrCl 11-29: 2 g q24H; CrCL <11: 2gx1, then 1g q24H; HD: 1g q24H, give after dialysis; PD: 2g q48H
• All other infections: CrCl 30-60: give q24h; CrCl 11-29: give usual dose x1, then 0.5-1 g q24h; CrCl <11: give usual dose x1, then 250-500mg q24h; HD: 1 g x1, then 500mg q24h, give after dialysis; PD: give usual dose q48h

Hepatic Dosing

• no adjustment

Pediatric Dosing

Bacterial Infections

• >2 mo: Dose: 50mg/kg IV/IM q12h; Max: 2 g/dose; Info: duration varies with infection type, severity; IM only for mild-mod. UTI due to E. coli

Febrile Neutropenia

• >2 mo: Dose: 50mg/kg IV q8h; Max: 2 g/dose

Respiratory Infections, cystic fibrosis patients

• >2 mo: Dose: 50mg/kg IV q8h x2wk; Max: 2 g/dose

Renal Dosing

• Febrile Neutropenia, cystic fibrosis: CrCl 30-60: 50mg/kg q12h; CrCl 11-29: 50mg/kg q24h; CrCl <11: 50mg/kg x1, then 25mg/kg q24h; HD: 25mg/kg q24h, give after dialysis; PD: 50mg/kg q48h
• all other infections: CrCl 30-60: 50mg/kg q24h; CrCl 11-29: 50mg/kg x1, then 25-50mg/kg q24h; CrCl <11: 50mg/kg x1, then 12.5-25mg/kg q24h; HD: 50mg/kg x1, then 25mg/kg q24h, give after dialysis; PD: 50mg/kg q48h

Hepatic Dosing

• No Adjustment

Special Populations

• Pregnancy: B
• Lactation: Probably safe
• Renal Dosing
  • Adult: CrCl 30-60: give q24h; CrCl 11-29: give usual dose x1, then 0.5-1 g q24h; CrCl <11: give usual dose x1, then 250-500mg q24h; HD: 1 g x1, then 500mg q24h, give after dialysis; PD: give usual dose q48h
  • Pediatric: CrCl 30-60: 50mg/kg q24h; CrCl 11-29: 50mg/kg x1, then 25-50mg/kg q24h; CrCl <11: 50mg/kg x1, then 12.5-25mg/kg q24h; HD: 50mg/kg x1, then 25mg/kg q24h, give after dialysis; PD: 50mg/kg q48h
• Hepatic Dosing
  • Adult: No adjustment
  • Pediatric: No adjustement

Contraindications

• Allergy to class/drug (See also Cephalosporin Cross-reactivity
• Caution if hypersensitive to PCN
• Caution if recent antibiotic-associated colitis history
• Caution if GI disorder history
• caution if H. influenzae infection (pediatric patients)

Adverse Reactions

Serious

• Anaphylaxis
• Encephalopathy
• Seizures
• Non-convulsive status epilepticus
• Leukopenia
• Thrombocytopenia
• Agranulocytosis
• Anemia, hemolytic
• Aplastic anemia
• Hemorrhage
• Stevens-Johnson syndrome
• Toxic epidermal necrolysis
• Erythema multiforme
• Clostridium difficile associated diarrhea

Common

• Rash
• Injection site reaction
• Diarrhea
• Hypophosphatemia
• ALT, AST elevated
• Nausea

Pharmacology

• Half-life: 2 hours, 13.5 hours (HD), 19 hours (CAPD)
• Metabolism: minimal, site unknown; CYP450: unknown
• Excretion: urine primarily (85% unchanged)
• Mechanism of Action: bactericidal; inhibits cell wall mucopeptide synthesis

Antibiotic Sensitivities

Group	Organism	Sensitivity
Gram Positive	Strep. Group A, B, C, G	S
	Strep. Pneumoniae	S
	Viridans strep	S
	Strep. anginosus gp	X1
	Enterococcus faecalis	R
	Enterococcus faecium	X1
	MSSA	S
	MRSA	R
	CA-MRSA	R
	Staph. Epidermidis	I
	C. jeikeium	X1
	L. monocytogenes	R
Gram Negatives	N. gonorrhoeae	I
	N. meningitidis	S
	Moraxella catarrhalis	S
	H. influenzae	S
	E. coli	S
	Klebsiella sp	S
	E. coli/Klebsiella ESBL+	R
	E coli/Klebsiella KPC+	R
	Enterobacter sp, AmpC neg	S
	Enterobacter sp, AmpC pos	R
	Serratia sp	S
	Serratia marcescens	X1
	Salmonella sp	S
	Shigella sp	S
	Proteus mirabilis	S
	Proteus vulgaris	S
	Providencia sp.	S
	Morganella sp.	S
	Citrobacter freundii	S
	Citrobacter diversus	S
	Citrobacter sp.	S
	Aeromonas sp	S
	Acinetobacter sp.	I
	Pseudomonas aeruginosa	S
	Burkholderia cepacia	I
	Stenotrophomonas maltophilia	R
	Yersinia enterocolitica	S
	Francisella tularensis	X1
	Brucella sp.	X1
	Legionella sp.	R
	Pasteurella multocida	S
	Haemophilus ducreyi	X1
	Vibrio vulnificus	X1
Misc	Chlamydophila sp	X1
	Mycoplasm pneumoniae	X1
	Rickettsia sp	X1
	Mycobacterium avium	X1
Anaerobes	Actinomyces	X1
	Bacteroides fragilis	R
	Prevotella melaninogenica	R
	Clostridium difficile	R
	Clostridium (not difficile)	X1
	Fusobacterium necrophorum	X1
	Peptostreptococcus sp.	S

Key

• S susceptible/sensitive (usually)
• I intermediate (variably susceptible/resistant)
• R resistant (or not effective clinically)
• S+ synergistic with cell wall antibiotics
• U sensitive for UTI only (non systemic infection)
• X1 no data
• X2 active in vitro, but not used clinically
• X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
• X4 active in vitro, but not clinically effective for strep pneumonia

See Also

• Antibiotics (Main)

Source

• Epocrates

Authors

Mike Brown, Ross Donaldson, Neil Young, Daniel Ostermayer, Claire