Cefepime

DEA Class; Rx

Common Brand Names; Maxipime

Indicated for Treatment of moderate-to-severe pneumonia.

Empiric therapy in febrile neutropenic patients.

Treatment of uncomplicated and complicated urinary tract infections (UTIs), including pyelonephritis.

Treatment of uncomplicated skin and skin structure infections

Treatment of complicated intra-abdominal infections; use in combination with metronidazole

Documented hypersensitivity to cefepime, penicillins, or other beta-lactam antibiotics

• Positive Coombs test result without hemolysis (16%)
• Rash (1-4%)
• Elevated alanine aminotransferase (3%)
• Hypophosphatemia (3%)
• Diarrhea (<3%)
• Eosinophilia (2%)
• Erythema at injection site (2%)
• Normal partial thromboplastin time (PTT) (2%)
• Nausea or vomiting (<2%)
• Fever (1%)
• Headache (1%)
• Pain (1%)
• Pruritus (1%)
• Agranulocytosis
• Anaphylactic shock
• Anaphylaxis
• Coma
• Encephalopathy
• Hallucinations
• Leukopenia
• Myoclonus
• Neuromuscular excitability
• Neutropenia
• Seizures
• Thrombocytopenia

IM recommended only for mild-to-moderate complicated or uncomplicated UTI due to E coli

Prescribing drug in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to patient and increases risk of development of drug-resistant bacteria

Prolonged use may cause superinfection

May increase international normalized ratio (INR) with prolonged treatment, especially in nutritionally deficient patients

Caution warranted with history of previous immediate hypersensitivity reactions to cefepime, cephalosporins, penicillins, or other drugs; exercise caution if product is to be given to penicillin-sensitive patients; cross-hypersensitivity among beta-lactam antibacterials documented to occur up to 10% of patients with history of penicillin allergy; if allergic reaction to this drug occurs, discontinue drug and institute appropriate supportive measures

Use with caution in patients with GI disease, particularly colitis

If CrCl <60 mL/min, adjust dosage to compensate for slower renal elimination rate

There are no cases of drug exposure during pregnancy reported from postmarketing experience or from clinical trials; available data from published observational studies and case reports over several decades with cephalosporin use in pregnant women have not established drug-associated risks of major birth defects, miscarriage or adverse maternal or fetal outcomes

Drug is present in human milk at low concentration (0.5 mcg/mL); a nursing infant consuming approximately 1000 mL of human milk per day would receive approximately 0.5 mg of cefepime per day