From the Guidelines
Cefepime is not recommended for the treatment of urinary tract infections (UTIs) according to the most recent guidelines. The European Association of Urology guidelines on urological infections, published in 2024 1, do not mention cefepime as a recommended treatment option for UTIs. Instead, the guidelines recommend other antibiotics such as nitrofurantoin, trimethoprim-sulfamethoxazole, or ciprofloxacin for the treatment of uncomplicated UTIs. For complicated UTIs, the guidelines recommend treatment for 7-14 days, depending on the severity of the illness and local resistance patterns, but do not specifically recommend cefepime. Additionally, the ESCMID guidelines conditionally recommend against the use of cefepime for the treatment of extended-spectrum cephalosporin-resistant Enterobacterales (ESCR-E) infections, including UTIs 1. Therefore, based on the most recent and highest-quality evidence, cefepime is not recommended for the treatment of UTIs. Some key points to consider when treating UTIs include:
- Checking renal function and adjusting the dose of antibiotics accordingly
- Being aware of potential side effects such as diarrhea, nausea, and allergic reactions
- Considering the severity of the illness and local resistance patterns when selecting an antibiotic
- Using antibiotics with a narrower spectrum and lower cost for uncomplicated UTIs, reserving broader-spectrum antibiotics like cefepime for more severe infections or when first-line antibiotics have failed.
From the FDA Drug Label
The safety and effectiveness of cefepime in the treatment of uncomplicated and complicated urinary tract infections (including pyelonephritis) ... have been established
- Key Points:
- Cefepime is effective for treating uncomplicated and complicated urinary tract infections (including pyelonephritis)
- The safety and effectiveness of cefepime for these conditions have been established in patients 2 months up to 16 years
- Cefepime covers Urinary Tract Infections (UTI), including pyelonephritis, as the drug label explicitly states its effectiveness for these conditions 2
From the Research
Cefepime Coverage for Urinary Tract Infections (UTI)
- Cefepime, a fourth-generation cephalosporin, has been studied for its efficacy in treating UTIs, including complicated and uncomplicated cases 3, 4.
- Clinical trials have shown that cefepime can be used safely and successfully to treat both complicated and uncomplicated nosocomial infections of the urinary tract, including cases associated with concurrent bacteremia 3.
- The clinical and bacteriological efficacies of cefepime therapy have been reported to be 93.2% and 85.4%, respectively, in patients with complicated UTIs 4.
- Cefepime has been compared to other antibiotics, such as ceftazidime and piperacillin/tazobactam, and has been found to be noninferior or superior in terms of clinical cure and microbiological eradication 3, 5.
Types of UTIs Treated with Cefepime
- Cefepime has been used to treat complicated UTIs, including cases with concurrent bacteremia 3, 5.
- Uncomplicated UTIs have also been treated with cefepime, with reported clinical response and bacterial eradication rates of 92% and 85%, respectively 3.
- Acute pyelonephritis has been treated with cefepime, with good results reported in some studies 6, 5.
Comparison to Other Antibiotics
- Cefepime has been compared to ceftazidime, with similar clinical response and bacterial eradication rates reported for both antibiotics 3.
- Cefepime/enmetazobactam has been compared to piperacillin/tazobactam, with cefepime/enmetazobactam found to be noninferior and superior in terms of clinical cure and microbiological eradication 5.
- Other cephalosporins, such as cefixime, have also been used to treat UTIs, with reported efficacy and safety profiles similar to those of cefepime 6, 7.