From the Research
Cefepime is generally not considered nephrotoxic when used at appropriate doses in patients with normal kidney function. Unlike aminoglycosides or vancomycin, cefepime has a low risk of directly causing kidney damage 1. However, dose adjustment is necessary in patients with pre-existing renal impairment to prevent accumulation of the drug, which could lead to neurotoxicity rather than nephrotoxicity. The standard adult dose of cefepime is 1-2g every 12 hours for most infections, but this should be reduced based on creatinine clearance in patients with kidney disease.
Some key points to consider when using cefepime include:
- Monitoring renal function during cefepime therapy, especially in critically ill patients, those receiving other potentially nephrotoxic medications, or those with underlying kidney disease 2.
- Maintaining adequate hydration during treatment.
- Being aware that cefepime is primarily eliminated by the kidneys, with approximately 85% of the drug excreted unchanged in urine, which explains why dosage adjustments are necessary in renal impairment despite its low nephrotoxic potential 3.
- Recognizing that while cefepime-induced neurotoxicity is a concern, especially in patients with renal dysfunction, the risk of nephrotoxicity itself is low 4.
- Considering the rare possibility of acute interstitial nephritis, as reported in some cases, which underscores the importance of careful monitoring of renal parameters in patients on prolonged therapy with cefepime 1.
Overall, the use of cefepime requires careful consideration of the patient's renal function and adjustment of the dose accordingly to minimize the risk of neurotoxicity and other adverse effects 5, 4.