Cefpirome

General

• Type: 4th generation Cephalosporin
• Dosage Forms: powder for injection
• Dosage Strengths: 500mg, 1g
• Routes of Administration: IV
• Common Trade Names: Firstcin

Adult Dosing

General

• Standard: 500mg - 1g IV q12h
• Moderate-Severe: 1g IV q8h OR 2g IV q12h
• Life Threatening: 2g IV q8h
• Max: 4-6g/day

Pneumonia / Respiratory Tract Infections

• 1g IV q12h
• Effective against Pseudomonas aeruginosa

UTI, Complicated and Uncomplicated

• 0.5-1g IV q12h

Sepsis

• 1-2g IV q8-12h

Meningitis

• 2g IV q8h

Pediatric Dosing

General

• 40-80 mg/kg/day IV divided q6-8h or q12h
• Severe / Meningitis: Up to 100-120 mg/kg/day IV divided q6-8h
• Max: Adult daily maximum (typically 4g/day)

Special Populations

• Pregnancy: B
• Lactation: Excreted in breast milk; use with caution
• Renal
  • Adult
    • CrCl 60-100: No adjustment
    • CrCl 30-60: 0.5-1g q12h
    • CrCl 10-29: 0.5-1g q24h
    • CrCl <10: 0.5g q24h
    • Hemodialysis: Administer 0.5-1g supplement after dialysis
  • Pediatric
    • Adjust based on adult GFR guidelines (extend interval)
• Hepatic
  • No adjustment usually necessary

Contraindications

• Allergy to class/drug (Cephalosporins)
• History of anaphylactic shock to Penicillin

Adverse Reactions

Serious

• Anaphylaxis
• Stevens-Johnson Syndrome
• Clostridium difficile
• Seizures / Encephalopathy (especially in renal failure without dose adjustment)
• Neurotoxicity
• Agranulocytosis

Common

• Diarrhea
• Rash
• Nausea and Vomiting
• Abdominal Pain
• Phlebitis
• Transaminitis (Elevated AST/ALT)
• Eosinophilia

Pharmacology

• Half-life: 1.5 - 2h
• Metabolism: Minimally metabolized
• Excretion: Urine (largely unchanged)
• Mechanism of Action: Bactericidal; inhibits cell wall mucopeptide synthesis.
• Spectrum Note: A 4th generation agent with a quaternary ammonium group, allowing rapid penetration into Gram-negative bacteria and high stability against AmpC beta-lactamases.

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	R
	MSSA	S
	MRSA	R
	CA-MRSA	R
	Staph. Epidermidis	I
	C. jeikeium	R
	L. monocytogenes	R
Gram Negatives	N. gonorrhoeae	S
	N. meningitidis	S
	Moraxella catarrhalis	S
	H. influenzae	S
	E. coli	S
	Klebsiella sp	S
	E. coli/Klebsiella ESBL+	I
	E coli/Klebsiella KPC+	R
	Enterobacter sp, AmpC neg	S
	Enterobacter sp, AmpC pos	S
	Serratia sp	S
	Serratia marcescens	S
	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	R
	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	R
	Mycoplasm pneumoniae	R
	Rickettsia sp	R
	Mycobacterium avium	R
Anaerobes	Actinomyces	X1
	Bacteroides fragilis	R
	Prevotella melaninogenica	I
	Clostridium difficile	X1
	Clostridium (not difficile)	I
	Fusobacterium necrophorum	S
	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)