From the Guidelines
Cefepime is a fourth-generation cephalosporin antibiotic used to treat various bacterial infections, particularly those caused by gram-negative bacteria including Pseudomonas aeruginosa, with a recommended dosage of 4 to 6 g/d in patients with late pneumonia or presence of other risk factors for nonfermenting Gram-negative bacilli, as suggested by experts in the field 1.
Key Characteristics of Cefepime
- Cefepime is a broad-spectrum antibiotic effective against a wide range of gram-negative bacteria, including Pseudomonas aeruginosa.
- It is used to treat various infections, including hospital-acquired pneumonia, especially in patients with risk factors for nonfermenting Gram-negative bacilli.
- The standard dosage of cefepime varies depending on the infection type and severity, with 4 to 6 g/d being recommended for late pneumonia or presence of other risk factors for nonfermenting Gram-negative bacilli.
Mechanism of Action and Side Effects
- Cefepime works by inhibiting bacterial cell wall synthesis, specifically binding to penicillin-binding proteins to disrupt peptidoglycan formation.
- Common side effects include headache, nausea, and rash, while more serious concerns include neurotoxicity (especially in patients with kidney dysfunction) and Clostridioides difficile-associated diarrhea.
Clinical Considerations
- Cefepime should be used cautiously in patients with beta-lactam allergies, though cross-reactivity is less common than with other beta-lactams.
- When administering cefepime, clinicians should monitor renal function, assess for neurological symptoms, and be aware that therapeutic drug monitoring may be necessary in critically ill patients to ensure optimal dosing, as suggested by guidelines for the use of antimicrobial agents in neutropenic patients with cancer 1.
Treatment Guidelines
- Cefepime is recommended as an option for the treatment of hospital-acquired pneumonia in ICU patients, particularly those with late pneumonia or presence of other risk factors for nonfermenting Gram-negative bacilli, with a dosage of 4 to 6 g/d 1.
- The choice of cefepime should be based on the patient's individual risk factors, infection severity, and local antimicrobial resistance patterns.
From the FDA Drug Label
Cefepime for injection, USP is a semi-synthetic, broad spectrum, cephalosporin antibiotic for parenteral administration. Cefepime is a fourth-generation cephalosporin antibiotic.
- It is used for parenteral administration.
- The drug has a broad spectrum of activity against both Gram-positive and Gram-negative bacteria.
- Cefepime is a bactericidal agent that acts by inhibiting bacterial cell wall synthesis 2.
- It is highly resistant to hydrolysis by most beta-lactamases and exhibits rapid penetration into Gram-negative bacterial cells 2.
From the Research
Overview of Cefepime
- Cefepime is a broad-spectrum fourth-generation cephalosporin antibiotic with activity against Gram-positive and Gram-negative pathogens 3, 4, 5, 6, 7.
- It is generally administered as an infusion over 30-60 min or as a prolonged infusion with infusion times from 3 h to continuous administration 3.
Pharmacokinetics and Pharmacodynamics
- Cefepime is widely distributed in biological fluids and tissues with an average volume of distribution of ~ 0.2 L/kg in healthy adults with normal renal function 3.
- Protein binding is relatively low (20%), and elimination is mainly renal, with about 85% of the dose excreted unchanged in the urine 3.
- The elimination half-life of cefepime is approximately 2 hours 3, 4.
- The pharmacokinetics of cefepime can be altered under certain pathophysiological conditions, resulting in high inter-individual variability in cefepime volume of distribution and clearance 3.
Clinical Efficacy and Safety
- Cefepime has been shown to be effective in the treatment of various infections, including pneumonia, osteomyelitis, and septicemia 4, 5, 7.
- It is generally well-tolerated, with a tolerability profile similar to that of other parenteral cephalosporins 4, 5.
- Common adverse events include diarrhea, nausea, and pruritus 4, 5, 7.
- Cefepime has been associated with neurotoxicity, particularly in patients with impaired renal function 3.