Cefepime

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

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

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 PositiveStrep. Group A, B, C, GS
Strep. PneumoniaeS
Viridans strepS
Strep. anginosus gpX1
Enterococcus faecalisR
Enterococcus faeciumX1
MSSAS
MRSAR
CA-MRSAR
Staph. EpidermidisI
C. jeikeiumX1
L. monocytogenesR
Gram NegativesN. gonorrhoeaeI
N. meningitidisS
Moraxella catarrhalisS
H. influenzaeS
E. coliS
Klebsiella spS
E. coli/Klebsiella ESBL+R
E coli/Klebsiella KPC+R
Enterobacter sp, AmpC negS
Enterobacter sp, AmpC posR
Serratia spS
Serratia marcescensX1
Salmonella spS
Shigella spS
Proteus mirabilisS
Proteus vulgarisS
Providencia sp.S
Morganella sp.S
Citrobacter freundiiS
Citrobacter diversusS
Citrobacter sp.S
Aeromonas spS
Acinetobacter sp.I
Pseudomonas aeruginosaS
Burkholderia cepaciaI
Stenotrophomonas maltophiliaR
Yersinia enterocoliticaS
Francisella tularensisX1
Brucella sp.X1
Legionella sp.R
Pasteurella multocidaS
Haemophilus ducreyiX1
Vibrio vulnificusX1
MiscChlamydophila spX1
Mycoplasm pneumoniaeX1
Rickettsia spX1
Mycobacterium aviumX1
AnaerobesActinomycesX1
Bacteroides fragilisR
Prevotella melaninogenicaR
Clostridium difficileR
Clostridium (not difficile)X1
Fusobacterium necrophorumX1
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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