View source for Cefepime

==General==
*Type: Fourth generation [[Cephalosporins|cephalosporin]]
*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 [[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==
===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===
*[[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]]<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]]||'''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==
*[[Antibiotics (Main)]]

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

*Lexicomp
Accessed September 4, 2019