Cefepime

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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

Common

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[1]

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

References

  • Epocrates
  1. Sanford Guide to Antimicrobial Therapy 2014