Is cefepime (Cefepime) the same as ceftolozane/tazobactam (Ceftolozane/Tazobactam)?

Cefepime vs. Ceftolozane/Tazobactam: Distinct Antibiotics with Different Properties

No, cefepime is not the same as ceftolozane/tazobactam - they are distinct antibiotics with different antimicrobial spectrums, structures, and clinical applications.

Key Differences

Chemical Structure and Classification

• Cefepime: A fourth-generation cephalosporin antibiotic 1
• Ceftolozane/Tazobactam: A combination of a novel cephalosporin (ceftolozane) with a β-lactamase inhibitor (tazobactam) 2

Antimicrobial Spectrum

• Cefepime:

  • Has broader spectrum activity than third-generation cephalosporins
  • Effective against AmpC-producing organisms
  • Requires combination with metronidazole for anaerobic coverage 1
  • Has moderate activity against Pseudomonas aeruginosa
  • Less effective against ESBL-producing organisms

• Ceftolozane/Tazobactam:

  • Specifically designed with potent activity against multidrug-resistant Gram-negative bacilli
  • Particularly effective against Pseudomonas aeruginosa, including carbapenem-resistant strains
  • Active against ESBL-producing Enterobacteriaceae (due to tazobactam component)
  • Covers some anaerobic species 2

Clinical Applications

• Cefepime:

  • Used for various infections including HAP/VAP
  • Often used for empiric therapy in mild-to-moderate infections
  • May be used in combination therapy for serious infections 1

• Ceftolozane/Tazobactam:

  • FDA-approved for complicated urinary tract infections, complicated intra-abdominal infections, and hospital-acquired/ventilator-associated bacterial pneumonia
  • Particularly valuable for suspected or documented infections with MDR Pseudomonas aeruginosa
  • Can provide an alternative to carbapenems for ESBL-producing organisms 3

Safety Considerations

• Cefepime:

  • Has a higher risk of neurotoxicity compared to some other beta-lactams
  • Relative pro-convulsive activity of 160 (compared to penicillin G at 100)
  • Neurotoxicity risk increases with renal impairment 1

• Ceftolozane/Tazobactam:

  • Generally well-tolerated with safety profile consistent with other cephalosporins 2

Clinical Evidence

In hospital-acquired and ventilator-associated pneumonia (HAP/VAP) caused by resistant Gram-negative bacteria, ceftolozane/tazobactam has demonstrated high-certainty evidence for non-inferiority to meropenem, while cefepime has very low-certainty evidence 1.

Practical Implications

When selecting between these antibiotics, consider:

1. Resistance patterns: Ceftolozane/tazobactam maintains activity against many MDR organisms that may be resistant to cefepime
2. Infection site: Both have different approved indications
3. Patient factors: Cefepime requires more caution in patients with renal impairment due to neurotoxicity risk
4. Antimicrobial stewardship: Ceftolozane/tazobactam may serve as a carbapenem-sparing option in appropriate settings 3

In summary, while both medications are beta-lactam antibiotics, they have significant differences in structure, antimicrobial spectrum, and clinical applications that make them distinct therapeutic options.