From the Guidelines
Cefepime is not recommended for the treatment of urinary tract infections (UTIs) caused by multidrug-resistant Gram-negative bacilli, according to the latest guidelines. The European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines, published in 2022 1, suggest that cefepime should not be used for the treatment of infections caused by 3GCephRE, including complicated UTIs. This recommendation is based on the conditional recommendation against use, with very low certainty of evidence.
For patients with complicated UTIs, the guidelines recommend the use of intravenous fosfomycin, which has a strong recommendation for use and high certainty of evidence 1. Alternatively, aminoglycosides may be used for short durations of therapy, when active in vitro, with a conditional recommendation for use and moderate certainty of evidence 1.
It is essential to note that the treatment of UTIs should be guided by the severity of the infection, the susceptibility pattern of the isolate, and antibiotic stewardship considerations. In general, simpler oral antibiotics like nitrofurantoin, trimethoprim-sulfamethoxazole, or fosfomycin are preferred for uncomplicated UTIs, while more broad-spectrum antibiotics like cefepime may be reserved for hospitalized patients with complicated UTIs or infections caused by resistant organisms. However, based on the latest guidelines, cefepime is not a recommended option for the treatment of UTIs caused by multidrug-resistant Gram-negative bacilli.
Key points to consider when treating UTIs include:
- The severity of the infection
- The susceptibility pattern of the isolate
- Antibiotic stewardship considerations
- The potential for resistance and side effects
- The need for dose adjustments in patients with renal impairment.
From the FDA Drug Label
Uncomplicated and Complicated Urinary Tract Infections (including pyelonephritis) caused by Escherichia coli or Klebsiellapneumoniae, when the infection is severe, or caused by Escherichia coli, Klebsiellapneumoniae, or Proteus mirabilis, when the infection is mild to moderate, including cases associated with concurrent bacteremia with these microorganisms Cefepime is indicated for the treatment of Uncomplicated and Complicated Urinary Tract Infections (UTIs), including pyelonephritis, caused by susceptible strains of Escherichia coli, Klebsiellapneumoniae, or Proteus mirabilis 2.
- Key points:
- Cefepime is effective against severe UTIs caused by Escherichia coli or Klebsiellapneumoniae
- Cefepime is effective against mild to moderate UTIs caused by Escherichia coli, Klebsiellapneumoniae, or Proteus mirabilis The use of cefepime for UTI treatment should be guided by culture and susceptibility information, and local epidemiology and susceptibility patterns should be considered in the empiric selection of therapy.
From the Research
Efficacy of Cefepime for UTI
- Cefepime has been shown to be effective in treating urinary tract infections (UTIs), including complicated and uncomplicated cases 3.
- In a study comparing cefepime and ceftazidime, cefepime produced a satisfactory clinical response in 89% of patients with complicated UTIs and 92% of patients with uncomplicated UTIs 3.
- Cefepime has also been found to be effective in eradicating pathogens, with an eradication rate of 85% in complicated UTIs and 85% in uncomplicated UTIs 3.
Comparison with Other Antibiotics
- Cefepime is considered a valuable addition to the treatment of serious infections, including UTIs, due to its broad-spectrum activity 3.
- In a review of treatment options for UTIs, cefepime was listed as a potential option for treating UTIs caused by multidrug-resistant organisms, including ESBL-producing Enterobacteriaceae and carbapenem-resistant Enterobacteriaceae 4.
- A network meta-analysis found that cefepime + enmetazobactam was associated with significantly higher relative risks of efficacy endpoints, including composite outcome and microbiological eradication, compared to carbapenems 5.
Use in Specific Populations
- Cefepime has been found to be effective in treating serious UTIs in children, with a favorable clinical and microbiologic response observed in >95% of cefepime-treated children 6.
- Cefepime is considered an important therapeutic option for the treatment of serious UTIs in children, particularly in cases where other antibiotics may not be effective 6.