Can cefepime (Cefepime) be used to treat Pseudomonas urinary tract infections (UTI)?

From the Guidelines

Cefepime can be used to treat urinary tract infections (UTIs) caused by Pseudomonas aeruginosa, as it is a fourth-generation cephalosporin with excellent activity against Pseudomonas. According to the European Association of Urology guidelines on urological infections, published in 2024 1, the treatment of complicated UTIs should be guided by local resistance patterns and specific host factors, and a urine culture and susceptibility testing should be performed. Cefepime is often prescribed at a dose of 1-2 grams intravenously every 12 hours for 7-14 days, depending on infection severity, and dose adjustments are necessary for patients with renal impairment. The guidelines also recommend managing any urological abnormality and/or underlying complicating factors, and considering the microbial spectrum and antimicrobial resistance when choosing an antibiotic.

The European Association of Urology guidelines also provide recommendations for the treatment of complicated UTIs, including the use of a combination of antibiotics, such as amoxicillin plus an aminoglycoside, or a second-generation cephalosporin plus an aminoglycoside 1. However, cefepime is a suitable option for treating Pseudomonas infections, especially when local antibiotic resistance patterns are considered. It's worth noting that cefepime works by inhibiting bacterial cell wall synthesis and has good urinary tract penetration, with high concentrations achieved in the urine, making it a valuable option for treating Pseudomonas infections, which are often resistant to many other antibiotics.

Some key points to consider when using cefepime to treat UTIs caused by Pseudomonas aeruginosa include:

• Local antibiotic resistance patterns should be considered when choosing an antibiotic
• A urine culture and susceptibility testing should be performed to guide treatment
• Dose adjustments are necessary for patients with renal impairment
• Cefepime is often prescribed at a dose of 1-2 grams intravenously every 12 hours for 7-14 days, depending on infection severity
• Common side effects include gastrointestinal disturbances, rash, and rarely neurotoxicity, especially in patients with renal impairment or when using high doses.

Overall, cefepime is a suitable option for treating UTIs caused by Pseudomonas aeruginosa, especially when local antibiotic resistance patterns are considered, and its use should be guided by the European Association of Urology guidelines on urological infections 1.

From the FDA Drug Label

The safety and effectiveness of cefepime in the treatment of uncomplicated and complicated urinary tract infections (including pyelonephritis) have been established

• Cefepime can be used to treat urinary tract infections (UTIs), including complicated UTIs.
• However, the provided text does not specifically mention Pseudomonas as a target pathogen for cefepime in the treatment of UTIs.
• Given the lack of direct information about Pseudomonas in the context of UTI treatment with cefepime, a conservative clinical decision would be to consult additional resources or consider alternative treatments with established efficacy against Pseudomonas 2.

From the Research

Cefepime for Treating Pseudomonas UTI

• Cefepime is a fourth-generation cephalosporin with potent in vitro activity against Pseudomonas aeruginosa 3.
• The pharmacodynamic considerations for cefepime in treating moderate to severe pseudomonal infections suggest that it can be effective when serum levels exceed the MIC for 60-70% of the dosing interval 3.
• However, there is limited direct evidence on the use of cefepime specifically for treating Pseudomonas UTI.
• A study on the treatment of urinary tract infections, including complicated and uncomplicated cases, found that cefepime produced a satisfactory clinical response in 89% of patients with complicated UTI and 92% of patients with uncomplicated UTI 4.
• Another study suggested that cefepime can be used safely and successfully to treat both complicated and uncomplicated nosocomial infections of the urinary tract, including cases associated with concurrent bacteremia 4.

Comparison with Other Antibiotics

• Cefepime has been compared to other antibiotics, such as ceftazidime, in the treatment of UTIs, and has shown similar efficacy and safety profiles 4.
• A study on the use of cefepime or piperacillin/tazobactam to decrease the use of carbapenems in ESBL-producing Enterobacterales urinary tract infections found that cefepime resulted in similar clinical cure rates compared to carbapenems 5.
• The combination of cefepime with other antibiotics, such as taniborbactam, has also been investigated for the treatment of complicated urinary tract infections and acute pyelonephritis caused by carbapenem-susceptible gram-negative bacteria 6.

Limitations and Future Directions

• Further research is needed to fully evaluate the efficacy and safety of cefepime for treating Pseudomonas UTI, particularly in comparison to other antibiotics and in patients with specific underlying conditions or comorbidities.
• The emergence of antibiotic-resistant bacteria, including carbapenem-resistant Enterobacterales, highlights the need for continued development and evaluation of new antibiotic therapies, including combinations of existing antibiotics 7, 6.