Is there an oral version of Cefepime (cefepime) available?

Cefepime is Not Available in Oral Formulation

No, there is no oral version of cefepime available. Cefepime is only available as an intravenous (IV) or intramuscular (IM) formulation for parenteral administration 1.

Administration Routes for Cefepime

Cefepime is a fourth-generation cephalosporin that can only be administered through:

• Intravenous (IV) infusion (most common)
• Intramuscular (IM) injection

The pharmacokinetic properties of cefepime necessitate parenteral administration:

• It has limited oral bioavailability
• It is primarily eliminated via renal excretion as unchanged drug 2
• Its elimination half-life is approximately 2-2.5 hours 2

Oral Alternatives When Switching from IV Cefepime

When transitioning from IV cefepime to oral therapy (IV-to-PO switch), several alternatives may be considered based on the infection being treated:

For Febrile Neutropenia:

• First choice: Ciprofloxacin plus amoxicillin-clavulanate for adults 1, 3
• For children: Cefixime has been studied as an oral step-down therapy 1, 3

For Respiratory Infections:

• Amoxicillin-clavulanate
• Fluoroquinolones (levofloxacin, moxifloxacin)
• Oral cephalosporins (cefuroxime axetil, cefpodoxime proxetil, cefdinir) 1

For Other Infections:

• Selection should be based on culture results, local antibiogram data, and the specific pathogens being targeted

Important Clinical Considerations

1. Patient eligibility: Only switch to oral therapy when the patient shows clinical improvement and is hemodynamically stable

2. Spectrum coverage: Ensure the oral alternative covers the same pathogens as cefepime

   • Cefepime has activity against both gram-positive and gram-negative bacteria, including Pseudomonas aeruginosa 4, 5
   • No single oral antibiotic matches cefepime's complete spectrum

3. Bioavailability: Consider the bioavailability of oral alternatives when determining dosing

4. Resistance patterns: Local antibiogram data should guide selection of appropriate oral therapy

Common Pitfalls to Avoid

• Inadequate spectrum coverage: Cefepime has broader spectrum than most oral antibiotics, particularly against Pseudomonas and resistant Enterobacterales
• Premature switch: Switching too early before clinical improvement may lead to treatment failure
• Inappropriate oral agent selection: Failing to match the oral agent's spectrum to the suspected or confirmed pathogen

When IV cefepime is required but oral therapy is preferred, consultation with an infectious disease specialist may be warranted to determine the most appropriate oral alternative based on the specific clinical scenario.