What bacteria does cefepime (Cefepime) sulbactam cover?

Antimicrobial Coverage of Cefepime-Sulbactam

Cefepime-sulbactam provides broad-spectrum coverage against many gram-positive and gram-negative bacteria, including extended-spectrum β-lactamase (ESBL) producers, Acinetobacter species, and Pseudomonas aeruginosa, making it an effective combination for treating multidrug-resistant infections. 1

Gram-Negative Coverage

• Cefepime alone has excellent activity against many gram-negative bacteria, including Pseudomonas aeruginosa, Enterobacter species, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, and other Enterobacteriaceae 2, 3
• The addition of sulbactam significantly enhances activity against:
  • Acinetobacter baumannii, including carbapenem-resistant strains 1, 4
  • ESBL-producing Enterobacteriaceae that may be resistant to cefepime alone 1
• Cefepime-sulbactam shows synergistic or partially synergistic activity against 91.6% of carbapenem-resistant Acinetobacter species 4
• The combination is particularly effective against multidrug-resistant (MDR) gram-negative pathogens that would otherwise be resistant to cefepime monotherapy 1

Gram-Positive Coverage

• Cefepime has activity against several gram-positive organisms including:
  • Methicillin-susceptible Staphylococcus aureus (MSSA) 2, 5
  • Streptococcus pneumoniae (including penicillin-sensitive, -intermediate and -resistant strains) 3
  • Streptococcus pyogenes (Group A streptococci) 2, 5
  • Viridans group streptococci 2
• The combination with sulbactam maintains this gram-positive coverage 1

Notable Limitations

• Not effective against:
  • Methicillin-resistant Staphylococcus aureus (MRSA) 2
  • Most Enterococcus species 2, 5
  • Stenotrophomonas maltophilia 2
  • Some carbapenemase-producing organisms (KPC producers) may remain resistant 6

Clinical Applications

• The combination is particularly valuable for treating:
  • Serious hospital-acquired infections with suspected multidrug-resistant pathogens 1
  • Infections in settings with high prevalence of ESBL-producing organisms 6, 1
  • Carbapenem-resistant Acinetobacter infections, where it shows synergistic activity 4
• Cefepime alone is recommended as monotherapy for empirical treatment of febrile neutropenia, covering P. aeruginosa and other serious gram-negative pathogens 6
• For intra-abdominal infections, cefepime requires combination with metronidazole for anaerobic coverage 6

Pharmacological Considerations

• The optimal ratio of cefepime to sulbactam appears to be 1:1 or 1:2 for maximum efficacy against resistant gram-negative bacteria 1
• Cefepime is stable against many common plasmid- and chromosomally-mediated beta-lactamases and is a poor inducer of AmpC beta-lactamases 3, 5
• Sulbactam provides beta-lactamase inhibition, extending the spectrum of cefepime against beta-lactamase producing organisms 1

Comparison to Other Antimicrobials

• Cefepime has broader spectrum activity than third-generation cephalosporins, particularly against gram-positive bacteria 7
• Unlike ceftazidime, cefepime maintains good activity against both gram-negative organisms and gram-positive pathogens such as streptococci 6, 3
• The addition of sulbactam makes cefepime-sulbactam a potential alternative to carbapenems for treating some multidrug-resistant infections, serving as a carbapenem-sparing option 1

In summary, cefepime-sulbactam provides comprehensive coverage against many clinically significant pathogens, including difficult-to-treat multidrug-resistant gram-negative bacteria, while maintaining the gram-positive coverage of cefepime.