Is there an oral (PO) version of cefepime?

No Oral Version of Cefepime Available

There is no oral (PO) version of cefepime available for clinical use. Cefepime is only available as a parenteral (intravenous or intramuscular) formulation 1, 2.

Background on Cefepime

• Cefepime is a fourth-generation cephalosporin that is administered parenterally (intravenously or intramuscularly) 1
• It has a broad spectrum of antibacterial activity against both Gram-positive and Gram-negative bacteria, including many organisms resistant to third-generation cephalosporins 3
• Cefepime is primarily used for serious infections such as:
  • Febrile neutropenia 4
  • Prosthetic joint infections 4
  • Nosocomial pneumonia 3
  • Complicated urinary tract infections 5

Administration Routes for Cefepime

• Cefepime is only available in parenteral formulations for:
  • Intravenous (IV) administration 2
  • Intramuscular (IM) administration 2
• The typical dosage ranges from 1-2g administered every 8-12 hours, depending on the infection type and severity 3

Why No Oral Formulation Exists

• Cefepime has poor oral bioavailability, which prevents effective absorption through the gastrointestinal tract 2
• Its pharmacokinetic properties make it unsuitable for oral administration, as it would not achieve therapeutic concentrations 1
• Cefepime is primarily excreted unchanged by the kidneys (over 80%), indicating limited metabolism that would be necessary for an effective prodrug formulation 2

Oral Alternatives When Step-Down Therapy Is Needed

When transitioning from IV cefepime to oral therapy (step-down approach), clinicians typically choose from:

• For respiratory infections:

  • Oral fluoroquinolones (e.g., ciprofloxacin, levofloxacin) 4
  • Oral cephalosporins (e.g., cefpodoxime, cefuroxime) 4

• For febrile neutropenia in low-risk patients:

  • Ciprofloxacin plus amoxicillin-clavulanate 4

• For urinary tract infections:

  • Oral fluoroquinolones 6
  • Oral third-generation cephalosporins like cefixime 6

Clinical Implications

• The lack of an oral cefepime formulation means that patients requiring this specific antibiotic must receive it parenterally 1

• For patients who need to continue cefepime-like coverage after hospital discharge, options include:

  1. Outpatient parenteral antibiotic therapy (OPAT) with cefepime 4
  2. Switching to an appropriate oral alternative based on culture results and clinical response 4
  3. Using other oral cephalosporins with similar but not identical coverage (e.g., cefixime, cefpodoxime) 4

• The WHO guidelines specifically note that cefepime is only available as a parenteral agent and recommend alternative agents when oral therapy is required 4