Cefepime: Difference between revisions

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==General==
==General==
*Type:  
*Type: [[Is Generation::4th generation]] [[Is DrugClass::cephalosporins]]
*Dosage Forms:
*Dosage Forms: infusion solution, powder for injection
*Common Trade Names:  
*Dosage Strengths: infusion solution: 1g/50mL, 2g/100mL; powder for injection: 1g, 2g
*Routes of Administration: IV, IM
*Common Trade Names: Maxipime


==Adult Dosing==
==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==
==Pediatric Dosing==
*Mild to moderate infection: 50 mg/kg/dose every 12 hours; maximum dose: 2,000 mg/dose
*Severe infection: 50 mg/kg/dose every 8 to 12 hours; maximum dose: 2,000 mg/dose
===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==
==Special Populations==
*Pregnancy:
*Pregnancy: B
*Lactation:
*Lactation: Probably safe
*Renal Dosing
*Renal Dosing
**Adult
**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
**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
*Hepatic Dosing
**Adult
**Adult: No adjustment
**Pediatric
**Pediatric: No adjustement


==Contraindications==
==Contraindications==
*Allergy to class/drug
*Allergy to class/drug (See also [[EBQ:Cephalosporin Cross-reactivity|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==
==Adverse Reactions==
===Serious===
===Serious===
*[[Anaphylaxis]]
*[[Encephalopathy]] (patients with renal insufficiency more prone)
*[[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===
===Common===
*[[Rash]]
*Injection site reaction
*[[Diarrhea]]
*[[Hypophosphatemia]]
*ALT, AST elevated
*Nausea


==Pharmacology==
==Pharmacology==
*Half-life:  
*Half-life: 2 hours, 13.5 hours (HD), 19 hours (CAPD)
*Metabolism:  
*Metabolism: minimal, site unknown; CYP450: unknown
*Excretion:  
*Excretion: urine primarily (85% unchanged)
*Mechanism of Action:
*Mechanism of Action: bactericidal; inhibits cell wall mucopeptide synthesis
 
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
{| class="wikitable"
| align="center" style="background:#f0f0f0;"|'''Group'''
| align="center" style="background:#f0f0f0;"|'''Organism'''
| align="center" style="background:#f0f0f0;"|'''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]]||'''[[Has Antipseudomonal::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===
{{Template:Antibacterial Spectra Key}}


==See Also==
==See Also==
*[[Antibiotics (Main)]]
*[[Antibiotics (Main)]]


==Source==
==References==
*Epocrates
<references/>
[[Category:Pharmacology]]


<references/>
*Lexicomp
[[Category:Drugs]]
Accessed September 4, 2019

Latest revision as of 18:14, 18 July 2025

General

  • Type: 4th generation cephalosporins
  • Dosage Forms: infusion solution, powder for injection
  • Dosage Strengths: infusion solution: 1g/50mL, 2g/100mL; powder for injection: 1g, 2g
  • Routes of Administration: 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

  • Mild to moderate infection: 50 mg/kg/dose every 12 hours; maximum dose: 2,000 mg/dose
  • Severe infection: 50 mg/kg/dose every 8 to 12 hours; maximum dose: 2,000 mg/dose

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 (patients with renal insufficiency more prone)
  • 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

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
  • Lexicomp

Accessed September 4, 2019

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