Cefepime

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Generic Name of Cefepime - Learn More

Cefepime

Cefepime Precaution - What You Need to Know

- Special Populations: Cefepime is a fourth-generation cephalosporin antibiotic, which is classified as Pregnancy Category B. Studies in animals have not shown evidence of harm to the fetus, but there are no adequate and well-controlled studies in pregnant women. Cefepime should be used during pregnancy only if the potential benefits outweigh the risks. It is excreted in breast milk in small amounts, so it should be used cautiously in breastfeeding women. Decisions regarding the use of Cefepime in lactating women should weigh the clinical need against potential risks to the infant.
- Renal Impairment: Cefepime is primarily excreted unchanged in the urine. Therefore, dose adjustments are required in patients with renal impairment to prevent drug accumulation. In patients with a creatinine clearance (CrCl) less than 60 mL/min, the dose and/or dosing interval should be adjusted based on the severity of renal dysfunction.
- Monitoring Parameters: It is important to monitor renal function in patients receiving Cefepime, especially those with pre-existing kidney issues. Additionally, patients should be monitored for allergic reactions, as hypersensitivity reactions to cephalosporins can occur. Prolonged use or higher doses of Cefepime can lead to neurotoxicity, so monitoring for signs of central nervous system (CNS) side effects (e.g., confusion, seizures) is essential.
- Misuse or Dependency: Cefepime does not carry a risk of misuse or dependency. However, improper use or overuse of antibiotics, including Cefepime, can lead to the development of antibiotic-resistant bacteria. Patients should be educated about completing the full course of therapy and the importance of appropriate antibiotic use to combat resistance.

Cefepime Indication - Uses and Benefits

- Primary Indications: Cefepime is indicated for the treatment of a variety of moderate to severe bacterial infections. These include:
- Nosocomial pneumonia
- Skin and soft tissue infections
- Febrile neutropenia
- Intra-abdominal infections
- Urinary tract infections (UTIs)
- Meningitis caused by susceptible organisms (e.g., *Streptococcus pneumoniae*, *Neisseria meningitidis*)
- Evidence-Based Context: Cefepime has a broad spectrum of activity and is effective against both Gram-positive and Gram-negative bacteria, including many organisms resistant to other cephalosporins. Clinical guidelines recommend its use in treating hospital-acquired infections, including those caused by *Pseudomonas aeruginosa*, *Enterobacter* species, and other multidrug-resistant organisms.
- Off-label Uses: While Cefepime is not typically used for outpatient infections, it may be used off-label in severe infections caused by multidrug-resistant organisms in critically ill patients. It has been used in some cases for infections in immunocompromised individuals, such as those undergoing chemotherapy or those with HIV/AIDS, though it is usually reserved for cases where other antibiotics are less effective or contraindicated.

Cefepime Contraindications - Important Warnings

- Exclusion Criteria: Cefepime is contraindicated in patients with known hypersensitivity to cephalosporins, penicillins, or any of the drug’s components. In patients with a history of anaphylaxis or other severe allergic reactions to beta-lactam antibiotics, Cefepime should be avoided.
- Rationale: The contraindications are primarily due to the risk of hypersensitivity reactions, which may be severe and life-threatening. Cross-reactivity can occur between cephalosporins and penicillins due to structural similarities.
- Age and Demographic Considerations: Cefepime is generally used in adults and pediatric patients (over 2 months of age). In elderly patients or those with renal impairment, the dose of Cefepime may need to be adjusted to avoid drug accumulation and potential neurotoxicity.

Cefepime Side Effects - What to Expect

- Common Side Effects: The most common side effects associated with Cefepime are gastrointestinal disturbances such as diarrhea, nausea, and vomiting. Other common adverse effects include headache, rash, and injection site reactions (for intravenous administration).
- Serious Side Effects: Serious side effects are less common but can include allergic reactions (e.g., anaphylaxis), seizures, and neurotoxicity, especially in patients with renal dysfunction. Cefepime can also cause Clostridium difficile-associated diarrhea, which can lead to severe colitis.
- Mitigation and Monitoring: To minimize gastrointestinal side effects, Cefepime should be administered slowly by IV infusion. Neurotoxic effects, such as seizures or confusion, can occur, particularly in patients with renal impairment. Patients should be monitored for these symptoms, and dosage adjustments should be made if renal function deteriorates. If signs of severe allergic reactions, diarrhea, or CNS effects occur, patients should discontinue the drug and seek immediate medical attention.

Cefepime Pregnancy Category ID - Safety Information

2

Cefepime Mode of Action - How It Works

- Mechanism: Cefepime works by inhibiting bacterial cell wall synthesis. It binds to and inactivates penicillin-binding proteins (PBPs), which are crucial for the cross-linking of peptidoglycan chains that form the bacterial cell wall. Without a proper cell wall, bacteria become structurally unstable and are lysed.
- Pharmacodynamics and Pharmacokinetics: Cefepime is bactericidal, meaning it kills bacteria by disrupting their cell walls. It has a broad spectrum of activity against both Gram-positive and Gram-negative bacteria. Cefepime is well absorbed after intravenous or intramuscular administration and reaches peak plasma concentrations quickly. It is widely distributed in tissues and body fluids, including the lungs and cerebrospinal fluid. The drug is primarily eliminated unchanged through the kidneys, with a half-life of about 2 hours.
- Distinctive Action: Cefepime is particularly effective against multidrug-resistant organisms, such as *Pseudomonas aeruginosa* and *Enterobacter* species, making it a preferred choice for hospital-acquired infections. Its stability against beta-lactamase-producing bacteria adds to its usefulness in treating infections caused by resistant pathogens.

Cefepime Drug Interactions - What to Avoid

- Drug-Drug Interactions: Cefepime can interact with several medications. It may increase the risk of nephrotoxicity when used with other nephrotoxic agents, such as aminoglycosides (e.g., gentamicin) or diuretics (e.g., furosemide). The concurrent use of Cefepime with probenecid, which inhibits renal excretion, may lead to increased plasma concentrations of Cefepime, potentially resulting in toxicity.
- Food and Alcohol Interactions: Cefepime can be taken with or without food. There are no significant interactions between Cefepime and alcohol, but alcohol consumption during antibiotic therapy can still increase the risk of gastrointestinal side effects or discomfort.
- Clinical Recommendations: When administering Cefepime with nephrotoxic drugs, renal function should be closely monitored. If combining Cefepime with probenecid, adjustments to the dosage or frequency may be necessary to prevent excessive drug levels. Patients should also be advised to maintain hydration to reduce the risk of nephrotoxicity.

Cefepime Adult Dose - Recommended Dosage

- Standard Dosage: The typical adult dosage for Cefepime varies depending on the infection being treated. For most infections, the usual dose is 1-2 grams IV every 12 hours. For more severe infections, doses may be increased to 2 grams every 8 hours.
- Administration: Cefepime is administered intravenously or intramuscularly. For IV administration, it should be given slowly over 30 minutes to reduce the risk of infusion-related reactions. The dosage may be adjusted depending on the severity of the infection, renal function, and the patient’s clinical response.
- Maximum Dosage: The maximum dose of Cefepime for most infections is 2 grams every 8 hours, but this may be adjusted for patients with renal impairment or in cases of particularly severe infections.

Cefepime Child Dose - Dosage for Children

- Pediatric Dosing: Cefepime is indicated for use in children over 2 months of age. The recommended dose for pediatric patients is typically 50 mg/kg every 12 hours for mild to moderate infections, with a maximum dose of 2 grams per dose. For more severe infections, the dose may be increased to 50 mg/kg every 8 hours.
- Safety and Efficacy: Cefepime has been shown to be effective and safe for treating bacterial infections in children, including respiratory and urinary tract infections. However, dosing must be tailored to the child’s weight and the severity of the infection to avoid overdose.
- Pediatric Monitoring: Children receiving Cefepime should be monitored for potential side effects, especially gastrointestinal issues and signs of allergic reactions. In infants and children with renal impairment, special attention to dosing adjustments and renal function is necessary.

Cefepime Renal Dose - Dosage for Kidney Conditions

- Renal Impairment: For patients with renal impairment, the dosage of Cefepime should be adjusted based on creatinine clearance (CrCl).
- CrCl 60-120 mL/min: Standard dosage (1-2 grams every 12 hours).
- CrCl 30-59 mL/min: Dose reduced to 1 gram every 12 hours.
- CrCl 15-29 mL/min: Dose reduced to 1 gram every 24 hours.
- CrCl <15 mL/min: Dose reduced to 0.5-1 gram every 24 hours.
- Monitoring Recommendations: Renal function should be monitored regularly in patients receiving Cefepime, especially those with known kidney disease, to prevent accumulation of the drug and the risk of neurotoxicity. Adjustments to the dosage should be made if there are changes in renal function during treatment.