Cefipime

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General

  • Type: Fourth generation 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

  • 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

References