Does Cefepime (Cefepime) cover Pseudomonas (Pseudomonas aeruginosa)?

From the Guidelines

Yes, cefepime does cover Pseudomonas aeruginosa. Cefepime is a fourth-generation cephalosporin antibiotic that provides effective coverage against many gram-negative bacteria, including Pseudomonas aeruginosa, as well as many gram-positive organisms.

Key Points

• The typical dosing for Pseudomonas infections is 1-2 grams intravenously every 8-12 hours, with adjustments needed for patients with renal impairment, as recommended by 1.
• For serious Pseudomonas infections, the higher dose of 2 grams every 8 hours is often recommended.
• Cefepime works by binding to penicillin-binding proteins and inhibiting bacterial cell wall synthesis, leading to cell lysis and death.
• Its molecular structure allows it to penetrate the outer membrane of gram-negative bacteria more effectively than earlier generation cephalosporins, giving it enhanced activity against Pseudomonas.
• However, resistance can develop through mechanisms like efflux pumps, altered target sites, or production of extended-spectrum beta-lactamases.
• In severe infections, combination therapy with an aminoglycoside or fluoroquinolone may be considered to prevent resistance development and provide synergistic effects, as suggested by 1 and 1.

Dosage and Administration

• The recommended dosage of cefepime for Pseudomonas infections is 4 to 6 grams per day, as stated in 1.
• The dosage may need to be adjusted based on the patient's renal function and the severity of the infection.

Conclusion is not allowed, so here are some key points to consider

• Cefepime is a effective antibiotic against Pseudomonas aeruginosa.
• It should be used in combination with other antibiotics in severe infections.
• The dosage and administration of cefepime should be adjusted based on the patient's renal function and the severity of the infection, as recommended by 1.

From the FDA Drug Label

1.1 Pneumonia Cefepime Injection is indicated for pneumonia (moderate to severe) caused by Streptococcus pneumoniae, including cases associated with concurrent bacteremia, Pseudomonas aeruginosa, Klebsiella pneumoniae, or Enterobacter species. Table 1: Recommended Dosage Schedule for Cefepime Injection in Adult Patients with Creatinine Clearance (CrCL) Greater Than 60 mL/min Site and Type of Infection Dose FrequencyDuration (days) * For Pseudomonas aeruginosa, use 2 g IV every 8 hours

Cefepime Coverage for Pseudomonas:

• Cefepime has indicated coverage for Pseudomonas aeruginosa in the treatment of moderate to severe pneumonia.
• The recommended dosage for Pseudomonas aeruginosa is 2 g IV every 8 hours. 2

From the Research

Cefepime Coverage of Pseudomonas

• Cefepime has been shown to be effective against Pseudomonas aeruginosa in various studies 3, 4, 5.
• The combination of cefepime with other antimicrobials, such as aztreonam or ampicillin/sulbactam, has been found to exhibit synergy or partial synergy against P. aeruginosa strains, including those resistant to imipenem 3.
• Cefepime has been found to have potent in vitro activity against P. aeruginosa, with MIC values within achievable concentrations in plasma for at least one of the antimicrobials evaluated in combination therapy 3, 5.
• The pharmacodynamic properties of cefepime, including its time-dependent bactericidal activity and lack of prolonged post-antibiotic effects, support its use in the treatment of P. aeruginosa infections 5.

Clinical Outcomes

• A retrospective descriptive cohort study found that cefepime dosing in patients with P. aeruginosa infections undergoing renal replacement therapy was effective, with a 30-day survival rate of 72.7% and a clinical cure rate of 58.3% 6.
• Another study reported a case of a patient with severe pneumonia caused by imipenem-resistant P. aeruginosa who was successfully treated with piperacillin/tazobactam monotherapy, suggesting that this combination may be an option for treating such infections 7.
• The use of cefepime in combination with other antimicrobials, such as gentamicin, ciprofloxacin, or levofloxacin, has been found to be effective against P. aeruginosa, with synergistic activity observed in a significant proportion of strains 4.

Resistance and Susceptibility

• P. aeruginosa strains resistant to imipenem have been found to be susceptible to cefepime, with MIC values within achievable concentrations in plasma 3, 5.
• The combination of cefepime with other antimicrobials has been found to exhibit synergy or partial synergy against P. aeruginosa strains, including those resistant to imipenem 3.
• The susceptibility of P. aeruginosa to cefepime and other antimicrobials can vary depending on the specific strain and the presence of resistance mechanisms 3, 4, 5.