From the Guidelines
Cefepime is not the first-line treatment for urinary tract infections (UTIs) and should only be considered for complicated UTIs or those caused by resistant bacteria, as recommended by the most recent guidelines 1. When considering treatment options for UTIs, it's essential to prioritize the most effective and safest choices. According to the American College of Physicians, best practice advice for UTIs includes prescribing short-course antibiotics with either nitrofurantoin for 5 days, trimethoprim–sulfamethoxazole (TMP–SMZ) for 3 days, or fosfomycin as a single dose for uncomplicated cystitis 1. For complicated UTIs, including those caused by resistant bacteria, cefepime may be an option due to its broad-spectrum activity against many gram-negative bacteria, including Pseudomonas aeruginosa and extended-spectrum beta-lactamase (ESBL) producing organisms 1. Key points to consider when using cefepime for UTIs include:
- The usual adult dosage for UTIs is 1-2 grams administered intravenously every 12 hours for 7-14 days, depending on infection severity.
- Cefepime requires intravenous administration, making it primarily used in hospital settings rather than for uncomplicated UTIs that can be treated with oral antibiotics.
- Patients should be monitored for side effects, including allergic reactions, gastrointestinal disturbances, and potential neurotoxicity, especially in those with kidney impairment where dose adjustment may be necessary. It's crucial to note that cefepime is not recommended as a first-line treatment for UTIs due to its potential for adverse effects and the availability of more effective and safer alternatives 1.
From the FDA Drug Label
Uncomplicated and Complicated Urinary Tract Infections (including pyelonephritis) caused by Escherichia coli or Klebsiellapneumoniae, when the infection is severe, or caused by Escherichia coli, Klebsiellapneumoniae, or Proteus mirabilis, when the infection is mild to moderate, including cases associated with concurrent bacteremia with these microorganisms Cefepime is indicated for the treatment of Uncomplicated and Complicated Urinary Tract Infections (UTIs), including pyelonephritis, caused by susceptible strains of certain microorganisms, such as:
- Escherichia coli
- Klebsiellapneumoniae
- Proteus mirabilis This indication is supported by the FDA drug label 2.
From the Research
Efficacy of Cefepime for UTI
- Cefepime is a fourth-generation cephalosporin with an extended-spectrum of activity against Gram-negative and Gram-positive pathogens, including those that cause urinary tract infections (UTIs) 3.
- Studies have shown that cefepime is effective in treating both complicated and uncomplicated UTIs, with satisfactory clinical response rates ranging from 83% to 92% 4, 5.
- Cefepime has been shown to be effective against a variety of uropathogens, including Escherichia coli and Proteus mirabilis, with eradication rates of 85% to 92% 4, 5.
Comparison with Other Antibiotics
- Cefepime has been compared to other antibiotics, such as ceftazidime, and has been shown to have a similar safety profile and efficacy in treating UTIs 4.
- Cefepime is also considered a treatment option for UTIs caused by antibiotic-resistant bacteria, including extended-spectrum β-lactamase (ESBL)-producing Enterobacteriales and multidrug-resistant Pseudomonas spp. 6.