Cefepime Use with WBC 12,000/μL
A WBC count of 12,000/μL (mild leukocytosis) is NOT a contraindication to cefepime use—in fact, cefepime is specifically indicated for infections in patients with elevated WBC counts, including those with severe infections and sepsis. 1
Clinical Context
The question appears to conflate leukocytosis (elevated WBC) with neutropenia (low neutrophil count), which are opposite conditions requiring clarification:
If This Patient Has Leukocytosis (WBC 12,000/μL with normal/elevated neutrophils):
- Cefepime is appropriate and commonly used for serious bacterial infections presenting with leukocytosis as part of the inflammatory response 1
- Leukocytosis (WBC >12,000/μL) is actually listed as a diagnostic criterion for sepsis, a condition where cefepime is a first-line agent 1
- No dose adjustment or special precautions are needed based solely on an elevated WBC count 1
If This Patient Actually Has Neutropenia (Despite the WBC being 12,000):
This scenario would require the WBC to be elevated due to other cell lines (lymphocytes, monocytes) while neutrophils remain low—an uncommon presentation. However, if neutropenic:
- Cefepime remains a first-line recommended agent for febrile neutropenia 1
- Monotherapy with cefepime 2g IV every 8-12 hours is appropriate for high-risk neutropenic patients with fever 1
- The IDSA guidelines specifically endorse cefepime as empiric monotherapy for neutropenic fever, providing broad coverage against Pseudomonas aeruginosa and other serious gram-negative pathogens 1
- The FDA conducted a comprehensive meta-analysis addressing earlier mortality concerns and found no statistically significant increase in 30-day mortality with cefepime use (RR 1.20,95% CI 0.82-1.76) 1
Specific Indications Where Cefepime Is Appropriate
Cefepime is indicated for:
- Febrile neutropenia as monotherapy 1
- Severe intra-abdominal infections (combined with metronidazole for anaerobic coverage) 1
- Nosocomial and community-acquired pneumonia 2
- Bacteremia and sepsis 1
- Infections in patients with hematologic malignancies 3
Important Caveats
MIC considerations: If treating documented gram-negative bacteremia, ensure the organism's cefepime MIC is <8 μg/mL, as MIC ≥8 μg/mL is associated with significantly higher mortality (54.8% vs 24.1%) 4
Dosing matters: Standard dosing is 2g IV every 8-12 hours for serious infections; inadequate dosing (particularly 1g every 12 hours) may lead to treatment failure when MICs approach the breakpoint 4
Renal adjustment required: Dose must be adjusted for renal insufficiency to prevent neurotoxicity 1
Bottom line: A WBC of 12,000/μL does not preclude cefepime use—proceed with standard dosing based on the suspected infection type and renal function.