Cefepime

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

Indications by Disease

Disease	Dose	Context
Acute cystitis	2gm IV q8hr	Inpatient
Diabetic foot infection	2g IV q12hrs	Inpatient DFI
Discitis	2g IV three times daily	Inpatient Therapy
Ludwig's angina	2 g IV q12 hrs	Immunocompromised
Neutropenic fever	2g IV q8hrs	Inpatient monotherapy
Peritonitis	2g IV once daily	Allergy/Prior exposure
Pneumonia (main)	2g q8h	ICU, Risk of Pseudomonas
Pneumonia (main)	2g q8h	HAP, High Risk
Pneumonia (main)	2g q8h	VAP, High Risk
Pyelonephritis	2gm IV q8hr	Adult Inpatient

Pediatric Dosing

Indications by Disease

Disease	Dose	Context
Cystic fibrosis	>2 mo: Dose: 50mg/kg IV q8h x2wk; Max: 2 g/dose	Respiratory Infections, cystic fibrosis patients
Ludwig's angina	50mg/kg IV q8hrs (max 2g)	Pediatric Immunocompromised
Neutropenic fever	50mg/kg IV q8hrs (max 2g)	Pediatric Inpatient
Pediatric fever of uncertain source	30mg/kg/dose	Neonatal 0-14 days with Ampicillin
Pneumonia (peds)	50mg/kg/dose q8hrs IV	Hospitalized PICU severely ill

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

• 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

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

• Antibiotics (Main)

References

• Epocrates

• Lexicomp

Accessed September 4, 2019