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. 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.
The typical treatment options for UTIs include fluoroquinolones, trimethoprim-sulfamethoxazole, and nitrofurantoin, among others. The choice of antibiotic should be based on local resistance patterns, patient factors, and the severity of the infection.
Cefepime is a broad-spectrum antibiotic that is usually reserved for more severe infections or when first-line antibiotics have failed. Its use should be guided by urine culture results and susceptibility testing to ensure effective treatment and minimize the risk of antibiotic resistance.
In general, the treatment duration for UTIs can range from 7 to 14 days, depending on the severity of the infection and the presence of complicating factors. Patients should be monitored for side effects, and the treatment should be adjusted accordingly.
It is essential to note that cefepime is not typically a first-line choice for uncomplicated UTIs, and simpler, narrower-spectrum antibiotics are usually preferred to help prevent the development of antibiotic resistance.
Some key points to consider when treating UTIs include:
- Obtaining urine culture results to guide therapy
- Considering local antibiotic resistance patterns
- Monitoring patients for side effects
- Adjusting treatment based on patient response and susceptibility testing
- Reserving broad-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, 5.
- A study published in 1996 compared the efficacy and safety of cefepime and ceftazidime in hospitalized patients with UTIs, finding that cefepime produced a satisfactory clinical response in 89% of patients with complicated UTIs and 92% of patients with uncomplicated UTIs 3.
- Another study published in 2003 found that cefepime had a clinical efficacy of 93.2% and bacteriological efficacy of 85.4% in patients with complicated UTIs 4.
- A more recent study published in 2022 compared the efficacy of cefepime/enmetazobactam and piperacillin/tazobactam in patients with complicated UTIs or acute pyelonephritis, finding that cefepime/enmetazobactam was superior to piperacillin/tazobactam in achieving clinical cure and microbiological eradication 5.
Safety and Side Effects
- While cefepime has been shown to be effective in treating UTIs, it can also cause side effects, including encephalopathy, as reported in a case study published in 2024 6.
- The study highlighted the importance of understanding the potential risks and side effects of cefepime, particularly in patients with a history of urinary tract infections 6.
- Other studies have also reported adverse events associated with cefepime, including headache, diarrhea, and vomiting, although these were generally mild to moderate in severity 3, 5.
Comparison to Other Antibiotics
- Cefepime has been compared to other antibiotics, including ceftazidime and piperacillin/tazobactam, in terms of its efficacy and safety in treating UTIs 3, 5.
- The results of these studies suggest that cefepime is a valuable option for the treatment of UTIs, particularly in cases where other antibiotics may be ineffective or contraindicated 3, 4, 5.