From the Guidelines
Cefepime does not provide reliable coverage against anaerobic bacteria. It is a fourth-generation cephalosporin with excellent activity against many gram-positive and gram-negative aerobic bacteria, including Pseudomonas aeruginosa, but it has poor activity against most anaerobes 1. For infections where anaerobic coverage is needed, cefepime should be combined with an antibiotic that has good anaerobic activity, such as metronidazole. The limited anaerobic coverage of cefepime is due to its molecular structure and mechanism of action, which does not effectively target the cell wall components of anaerobic bacteria.
Some key points to consider when using cefepime include:
- Cefepime has a broad spectrum of activity against gram-positive and gram-negative aerobic bacteria
- It has poor activity against most anaerobes, making it necessary to combine with an antibiotic like metronidazole for anaerobic coverage
- The choice of empiric antibiotic regimens in patients with intra-abdominal infections should be based on the clinical condition of the patients, the individual risk for infection by resistant pathogens, and the local resistance epidemiology 1
- In patients with complicated intra-abdominal infections, a short course of antibiotic therapy (3-5 days) after adequate source control is a reasonable option, but cefepime should be used in combination with metronidazole for adequate anaerobic coverage 1.
Overall, while cefepime is a useful antibiotic for treating certain types of infections, its lack of anaerobic coverage is a significant limitation that must be considered when selecting an empiric antibiotic regimen.
From the Research
Cefepime Coverage Against Anaerobes
- Cefepime is a fourth-generation cephalosporin antibiotic with a broad spectrum of activity against Gram-positive and Gram-negative bacteria [@\5@].
- However, the provided studies do not specifically mention cefepime's coverage against anaerobic bacteria.
- Other antibiotics, such as metronidazole, carbapenems (imipenem, meropenem, and ertapenem), and combinations of a penicillin and a beta-lactamase inhibitor, are effective against anaerobic organisms [@\2@].
- Imipenem-cilastatin has a wide spectrum of antimicrobial activity, including against anaerobes [@\1@, @\3@].
- Ceftazidime, another cephalosporin antibiotic, has a broad spectrum of activity but is less active against Staphylococcus aureus and anaerobes [@\4@].
Anaerobic Coverage
- Anaerobic infections are generally polymicrobial, requiring therapy that provides coverage of both anaerobes and aerobes [@\2@].
- The most effective antimicrobials against anaerobic organisms are metronidazole, carbapenems, and combinations of a penicillin and a beta-lactamase inhibitor [@\2@].
- Imipenem-cilastatin is effective against a wide range of pathogens, including anaerobes [@\1@, @\3@].