Cefipime

General

• Type: cephalosporin (4th generation)
• Dosage Forms: IM/IV
• Common Trade Names: Maxipime

Adult Dosing

• 1-2 g IV q12h

febrile neutropenia

• 2g IV q8h

UTI, mild-mod

• 0.5g - 1g q12h x 7-10days

UTI, severe

• 2g IV q12h x 10days

Pediatric Dosing

infection, bacterial

>2 months

50mg/kg IV/IM q12hr, max 2g/dose

febrile neutropenia

>2 months

50mg/kg IV/IM q8h; max 2g/dose

resp. infection, cystic fibrosis patients

> 2 months

50mg/kg IV/IM q8h; max 2g/dose

Special Populations

• Pregnancy: Category B (no evidence of risk in humans)
• Lactation: very small amount excreted, adverse effects unlikely, infant should be monitored closely
• Renal Dosing
  • Adult
    • febrile neutropenia
      • GFR 30-60: 2g q12h
      • GFR 11-29: 2g q24h
      • GFR < 11: 2g x1, then 1g q24h
      • HD: 1g q24, give after dialysis
      • PD: 2g q24h
    • all other infections
      • GFR 30-60: q24h dosing
      • GFR 11-29: give usual dose x1, then 0.5-1g q24
      • GFR < 11: give usual dose x1, then 250-500mg q24h
      • HD: 1g x1, then 500mg q24h, give after dialysis
      • PD: usual dose q48h
  • Pediatric
    • febrile neutropenia, cystic fibrosis
      • GFR 30-60: 50mg/kg q12h
      • GFR 11-29: 50mg/kg q24h
      • GFR < 11: 50mg/kg x1, then 25mg/kg q24
      • HD: 25mg/kg q24, give after dialysis
      • PD: 50mg/kg q48
    • all other infections
      • GFR 30-60: 50mg/kg q24
      • GFR 11-29: 50mg/kg x1, then 25-50mg/kg q24
      • GFR < 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 adjustment

Contraindications

• Allergy to class/drug

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
• C.difficile associated diarrhea

Common

• rash
• infection site reaction
• diarrhea
• hypophosphatemia
• ALT, AST elevation
• nausea

Pharmacology

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

See Also

• Antibiotics (Main)

Source

Authors

Ann Huang, Ross Donaldson, Neil Young, Daniel Ostermayer