Cefepime
Common Brand Names: Maxipime
Therapeutic Class: A cephalosporin antibiotic
Common Injectable Dosage Forms:
Powder for Injection: 500 mg in 15 mL vials, 1 g in 15 mL vials, ADD-vantage vials, and 100 mL piggyback bottles, and 2 g in 20 mL vials, ADD-vantage vials, and 100 mL piggyback bottles. *ADD-vantage is a trademark of Abbott Labs.
Dosage Ranges:
Moderate to severe pneumonia due to S. pneumoniae, P. aeruginosa, K. pneumoniae, or Enterobacter species: 1-2 g IV every 12 hours for 10 days.
Empiric therapy for febrile neutropenic patients: 2 g IV every 8 hours for at least 7 days.
Mild to moderate uncomplicated urinary tract infections, including pyelonephritis, due to E. coli, K. pneumoniae, or P. mirabilis: 0.5-1 g IV or IM (E. Coli only) every 12 hours for 7-10 days.
Severe uncomplicated or complicated urinary tract infections, including pyelonephritis, due to E. coli or K. pneumoniae: 2 g every 12 hours for 10 days.
Moderate to severe uncomplicated skin and skin structure infections due to S. aureus or S. pyogenes: 2 g IV every 12 hours for 10 days.
Complicated intra-abdominal infections (use with metronidazole) caused by E. coli, viridans group streptococci, P. aeruginosa, K. pneumoniae, Enterobacter species, or B. fragilis: 2 g IV every 12 hours for 7-10 days.
Dosing schedule for patients with impaired renal function:
Normal dose (CrC >60 mL/min): 500 mg every 12 hours, 1 g every 12 hours, 2 g every 12 hours, or 2 g every 8 hours.
CrC 30-60 mL/min: 500 mg every 24 hours, 1 g every 24 hours, 2 g every 24 hours, or 2 g every 12 hours.
CrC 11-29 mL/min: 500 mg every 24 hours, 500 mg every 24 hours, 1 g every 24 hours, or 2 g every 24 hours.
CrC <11 mL/min: 250 mg every 24 hours, 250 mg every 24 hours, 500 mg every 24 hours, or 1 g every 24 hours.
CAPD: 500 mg every 48 hours, 1 g every 48 hours, 2 g every 48 hours, 2 g every 48 hours.
Hemodialysis: 1 g on day one, then 500 mg every 24 hours thereafter.
Administration and Stability: Maxipime in the dry state should be stored between 2°-25°C (36°-77°F) and protected from light. Maxipime is compatible at concentrations between 1-40 mg/mL with the following IV infusion fluids: 0.9% Sodium Chloride Injection, 5% and 10% Dextrose Injection, M/6 Sodium Lactate Injection, 5% Dextrose and 0.9% Sodium Chloride Injection, Lactated Ringer's and 5% Dextrose Injection, Normosol-R, and Normosol-M in 5% Dextrose Injection. Maxipime in ADD-vantage vials are compatible in 5% Dextrose Injection or 0.9% Sodium Chloride Injection. These solutions may be stored up to 24 hours at 20°-25°C (68°-77°F) for 7 days at 2°-8°C (36°-46°F). IV solutions should be administered over 30 minutes. PH 4-6
Pharmacology/Pharmacokinetics: Cefepime exerts its bactericidal activity by inhibition on mucopeptide synthesis in the bacterial cell wall. It is widely bioavailable following IM or IV injection, with peak levels occurring in 1-2 hours after IM dosage. The drug is eliminated by renal tubular secretion. Spectrum of activity includes many gram-positive aerobic bacteria (S. aureus, S. pneumoniae, S. pyogenes, and viridans-group streptococci) and gram-negative aerobic bacteria (Enterobacter species, E. coli, K. pneumoniae, P. mirabilis, P. aeruginosa).
Drug and Lab Interactions: May give false-positive Coombs’ test. May give a false-positive reaction for glucose in the urine when using Clinitest tablets. Increases potential of nephrotoxicity and ototoxicity when used with aminoglycosides. Nephrotoxicity risk increases when used with strong diuretics such as furosemide.
Contraindications/Precautions: Contraindicated in patients hypersensitive to cephalosporins, penicillins, or other beta-lactam antibiotics. Use with caution and with dosage adjustments in patients with impaired renal function. As with nearly all antibacterial agents, pseudomembranous colitis can occur with use. This diagnosis should be considered in patients reporting severe or persistent diarrhea. Use with caution in patients with a history of GI disease, especially colitis. Pregnancy Category B.
Monitoring Parameters: Watch for signs of anaphylaxis, culture and sensitivity of specimen.
Adverse Effects: The most common adverse effects are local reactions including phlebitis, pain and/or inflammation. May also cause rash.
Common Clinical Applications: Used for the treatment of pneumonia, skin and skin structure infections, intra-abdominal infections, and urinary tract infections caused by susceptible organisms and as an empiric therapy for febrile neutropenic patients.