Cefepime

Indications
 Intravenous
Urinary tract infections
Adult: 0.5-1 g every 12 hr for 7-10 days. May be given via direct inj over 5 minutes or infuse over 30 minutes.
Child: 2 mth - 16 yr: ≤40 kg: 50 mg/kg every 12 hr for 7-10 days. May be given via direct inj over 5 minutes or infuse over 30 minutes. Dose may also be given via IM inj for mild-moderate infections; for IM inj, it should be given via deep inj into large muscle mass.
Renal impairment: Haemodialysis: 1 g on the 1st day of treatment, followed by 500 mg every 24 hr; dose should be given after haemodialysis on dialysis days and preferably at the same time each day. CAPD: Normal recommended doses every 48 hr.
CrCl (ml/min)Dosage Recommendation
30-600.5-1 g every 24 hr.
11-290.5 g every 24 hr.
≤100.25 g every 24 hr.

Intravenous
Empiric therapy for febrile neutropenic patients
Adult: 2 g every 8 hr for 7 days or until resolution of neutrpenia. For patients who remain neutropenic for >7 days despite fever resolution, the need for continued anti-microbial treatment should be reviewed. May be given via direct inj over 5 minutes or infuse over 30 minutes.
Child: 2 mth - 16 yr: ≤40 kg: 50 mg/kg every 8 hr for 7 days or until neutropenia resolves. May be given via direct inj over 5 minutes or infuse over 30 minutes.
Renal impairment: Haemodialysis: 1 g every 24 hr, dose should be given after haemodialysis on dialysis days and preferably at the same time each day. CAPD: Normal recommended doses every 48 hr.
CrCl (ml/min)Dosage Recommendation
30-602 g every 12 hr.
11-292 g every 24 hr.
≤101 g every 24 hr.

Intravenous
Moderate to severe pneumonia
Adult: 1-2 g every 12 hr for 10 days. May be given via direct inj over 5 minutes or infuse over 30 minutes.
Child: 2 mth - 16 yr: ≤40 kg: 50 mg/kg every 12 hr for 10 days. May be given via direct inj over 5 minutes or infuse over 30 minutes.
Renal impairment: Haemodialysis: 1 g on the 1st day of treatment, followed by 500 mg every 24 hr; dose should be given after haemodialysis on dialysis days and preferably at the same time each day. CAPD: Normal recommended doses every 48 hr.
CrCl (ml/min)Dosage Recommendation
30-601-2 g every 24 hr.
11-290.5-1 g every 24 hr.
≤100.25-0.5 g every 24 hr.

Intravenous
Complicated intra-abdominal infections
Adult: 2 g every 12 hr for 7-10 days. Usually used in combination with metronidazole. May be given via direct inj over 5 minutes or infuse over 30 minutes.
Renal impairment: Haemodialysis: 1 g on the 1st day of treatment, followed by 500 mg every 24 hr; dose should be given after haemodialysis on dialysis days and preferably at the same time each day. CAPD: Normal recommended doses every 48 hr.
CrCl (ml/min)Dosage Recommendation
30-602 g every 24 hr.
11-291 g every 24 hr.
≤100.5 g every 24 hr.

Intravenous
Uncomplicated skin and skin structure infections
Adult: 2 g every 12 hr for 10 days. May be given via direct inj over 5 minutes or infuse over 30 minutes.
Child: 2 mth - 16 yr: ≤40 kg: 50 mg/kg every 12 hr for 10 days. May be given via direct inj over 5 minutes or infuse over 30 minutes.
Renal impairment: Haemodialysis: 1 g on the 1st day of treatment, followed by 500 mg every 24 hr; dose should be given after haemodialysis on dialysis days and preferably at the same time each day. CAPD: Normal recommended doses every 48 hr.
CrCl (ml/min)Dosage Recommendation
30-60 2 g every 24 hr.
11-291 g every 24 hr.
≤100.5 g every 24 hr.


Incompatibility: Y-site admin: Acyclovir, amphotericin B, amphotericin B cholesteryl sulfate complex, chlordiazepoxide, chlorpromazine, cimetidine, famotidine, ciprofloxacin, filgrastim, floxuridine, ganciclovir, haloperidol, hydroxyzine, idarubicin, ifosfamide, magnesium sulfate, mannitol, mechlorethamine, meperidine, metoclopramide, mitomycin, mitoxantrone, morphine, nalbuphine, ofloxacin, ondansetron, plicamycin, prochlorperazine edisylate, promethazine, streptozocin, vancomycin, vinblastine, vincristine, cisplatin, dacarbazine, daunorubicin, diazepam, diphenhydramine, dobutamine, dopamine, doxorubicin, droperidol, enalaprilat, etoposide, etoposide phosphate. Admixture incompatibility: Metronidazole, vancomycin, gentamicin, tobramycin, netilmicin sulfate, aminophylline or solutions of ampicillin at concentrations >40 mg/ml.
Contraindications
 Hypersensitivity to cefepime or other cephalosporins.
Warnings / Precautions
 Renal impairment; history of penicillin or cephalosporin allergy; lactation, pregnancy. Caution when used in patients with history of GI diseases, especially colitis. May decrease prothrombin activity; monitor prothrombin time in patients with poor nutritional state, renal or hepatic impairment and those on prolonged treatment. Prolonged treatment may result in overgrowth of nonsusceptible organisms, resulting in superinfection. Consider the possibility of Clostridium difficile associated diarrhoea in patients who present with diarrhoea after treatment. Caution when used in patients with a history of seizures.
Adverse Reactions
 Positive Coombs' test without haemolysis; rash, pruritus; diarrhoea, nausea, vomiting; fever, headache; pain and erythema at inj site; agranulocytosis; anaphylactic shock; leucopenia; neutropenia; thrombocytopenia.
Overdose Reactions
 Symptoms include encephalopathy, myoclonus, seizures and neuromuscular excitability. Careful observation and supportive treatment are recommended. In the presence of renal insufficiency, haemodialysis may be used to remove cefepime from the body.
Drug Interactions
 Increased effect with high-dose probenecid; increased nephrotoxic potential with aminoglycosides.
See Below for More cefepime Drug Interactions
Mechanism of Actions
 Cefepime is a 4th generation cephalosporin which inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall by binding to one or more of the penicillin-binding proteins (PBPs).
Absorption: IM admin: Rapid and almost complete absorption.
Distribution: 16-19% bound to plasma proteins. Volume of distribution: 14-20 L; crosses the blood brain barrier. Penetrates into inflammatory fluid at concentrations of about 80% of serum levels.
Metabolism: Minimally hepatic.
Excretion: Plasma half-life: 2 hr. Excreted in urine with 85% as unchanged drug.
Storage Conditions
 Intravenous: In dry state: Store at 2-25°C and protected from light. After reconstitution: Cefepime solution is stable for 24 hr at controlled room temperature (2-25°C) and for 7 days under refridgeration (2-8°C).
ATC Classification
 J01DE01 - cefepime ; Belongs to the class of fourth generation cephalosporins. Used in the systemic treatment of infections.
Storage
 Intravenous: In dry state: Store at 2-25°C and protected from light. After reconstitution: Cefepime solution is stable for 24 hr at controlled room temperature (2-25°C) and for 7 days under refridgeration (2-8°C).
Available As
  • Cefepime 1000 mg
  • Cefepime 200 mg
  • Cefepime 2000 mg
  • Cefepime 250 mg
  • Cefepime 500 mg

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