Is cefepime (a fourth-generation cephalosporin antibiotic) effective for treating a urinary tract infection caused by Pseudomonas?

Cefepime for Pseudomonas UTI

Yes, cefepime is an appropriate treatment option for urinary tract infections caused by Pseudomonas aeruginosa, provided the isolate is susceptible on antimicrobial susceptibility testing. 1

Key Treatment Considerations

Susceptibility Testing is Essential

• Cefepime should only be used if the Pseudomonas isolate demonstrates in vitro susceptibility on your culture and sensitivity report 1
• The 2022 Taiwan guidelines explicitly list cefepime 2 g IV q8-12h as a recommended treatment for carbapenem-resistant Pseudomonas aeruginosa (CRPA) infections when the organism is susceptible to cefepime 1
• Treatment duration for complicated UTI should be 5-10 days 1

Dosing Recommendations

• For Pseudomonas infections specifically, use cefepime 2 g IV every 8-12 hours 1
• Consider extended infusion (over 3 hours) for organisms with higher MICs to optimize pharmacodynamic targets 1
• Adjust dose for renal function as needed 1

When Cefepime May NOT Be Appropriate

If your Pseudomonas isolate shows difficult-to-treat resistance (DTR-PA) - meaning it is non-susceptible to ceftazidime, cefepime, piperacillin/tazobactam, carbapenems, and fluoroquinolones - then cefepime should not be used 1

For DTR-PA urinary infections, preferred alternatives include:

• Ceftolozane/tazobactam as first-line 1
• Ceftazidime/avibactam as first-line 1
• Colistin-based therapy 1
• Imipenem/cilastatin/relebactam 1

Clinical Evidence Supporting Cefepime

• Historical studies demonstrate cefepime achieves 94% clinical cure rates for serious bacterial infections including UTIs 2
• Cefepime has documented efficacy against Pseudomonas aeruginosa in urinary tract infections with good bacterial eradication rates 3, 4
• The drug is stable against many beta-lactamases and is a poor inducer of type I beta-lactamases, making it effective against some resistant strains 4

Important Caveats

• Aminoglycoside monotherapy is only indicated for urinary tract infections caused by resistant Pseudomonas, not for other infection sites 1
• For simple cystitis due to susceptible Pseudomonas, a single-dose aminoglycoside may be sufficient 1
• Do not use cefepime empirically - wait for susceptibility results before selecting this agent 1
• Infectious disease consultation is highly recommended for multidrug-resistant organism infections 1

Bottom Line Algorithm

1. Check your susceptibility report - if cefepime shows "susceptible," proceed with cefepime 1
2. If susceptible: Use cefepime 2 g IV q8-12h for 5-10 days 1
3. If resistant or DTR-PA: Switch to ceftolozane/tazobactam or ceftazidime/avibactam 1
4. For uncomplicated cystitis only: Consider single-dose aminoglycoside if susceptible 1