From the Guidelines
Cefepime does not appear to be a recommended option for covering Streptococcus agalactiae (Group B strep) based on the provided guidelines. The guidelines from the CDC in 2010 1 recommend penicillin G, ampicillin, cefazolin, vancomycin, and clindamycin for intrapartum antibiotic prophylaxis for prevention of early-onset group B streptococcal disease, but do not mention cefepime. Cefepime is a fourth-generation cephalosporin with broad-spectrum activity, but its effectiveness against Group B Streptococcus is not explicitly stated in the guidelines.
Key Points to Consider
- The guidelines prioritize penicillin G as the first-line treatment for GBS infections due to its proven efficacy, narrower spectrum, and lower cost 1.
- Cefazolin is recommended as an alternative for patients with non-anaphylactic penicillin allergies, suggesting that it is effective against GBS 1.
- Vancomycin and clindamycin are reserved for penicillin-allergic women at high risk for anaphylaxis, implying that they are effective against GBS, but with certain limitations 1.
- The guidelines do not provide information on the use of cefepime for GBS infections, making it unclear whether it is an effective option.
Clinical Implications
- In clinical practice, it is essential to follow established guidelines and use recommended antibiotics for GBS infections to ensure effective treatment and prevent complications.
- If cefepime is considered for use in a patient with a GBS infection, it is crucial to weigh the potential benefits and risks, taking into account the patient's allergy history, renal function, and the severity of the infection.
- Further research or consultation with infectious disease experts may be necessary to determine the appropriateness of cefepime for GBS infections in specific clinical scenarios.
From the FDA Drug Label
At least 90 percent of the following bacteria exhibit an in vitro minimum inhibitory concentration (MIC) less than or equal to the susceptible breakpoint for cefepime. ... Gram-positive bacteria ... Streptococcus agalactiae
- Cefepime coverage: The drug label states that at least 90% of Streptococcus agalactiae exhibit an in vitro minimum inhibitory concentration (MIC) less than or equal to the susceptible breakpoint for cefepime.
- Clinical efficacy: However, the efficacy of cefepime in treating clinical infections due to Streptococcus agalactiae has not been established in adequate and well-controlled clinical trials 2.
- Conclusion: Based on the in vitro susceptibility data, cefepime may be effective against Streptococcus agalactiae, but clinical efficacy has not been established.
From the Research
Cefepime Coverage Against Streptococcus agalactiae
- Cefepime is a fourth-generation cephalosporin with a broad spectrum of antibacterial activity 3, 4, 5, 6.
- It has been shown to be active against Gram-positive organisms, including Streptococcus pneumoniae and Streptococcus pyogenes 3, 5, 6.
- Specifically, cefepime has been found to be active against Streptococcus agalactiae (Group B strep) in vitro 7.
- The study published in Chemotherapy in 1994 found that cefepime showed excellent activity against Streptococcus agalactiae, with all 36 strains tested being inhibited by the drug 7.
- This suggests that cefepime may be effective against Streptococcus agalactiae infections, although clinical efficacy would depend on various factors, including the severity of the infection and the patient's overall health 3, 4, 5, 6.