Can Cefepime Be Used to Treat Urinary Tract Infections?
Yes, cefepime is FDA-approved and highly effective for treating both uncomplicated and complicated urinary tract infections, including pyelonephritis, with dosing ranging from 0.5-2 g IV every 8-12 hours depending on infection severity. 1
FDA-Approved Indications and Dosing
Cefepime is specifically indicated for UTI treatment with the following dosing regimens 1:
Mild to moderate uncomplicated or complicated UTI (including pyelonephritis) due to E. coli, K. pneumoniae, or P. mirabilis: 0.5-1 g IV every 12 hours for 7-10 days 1
Severe uncomplicated or complicated UTI (including pyelonephritis) due to E. coli or K. pneumoniae: 2 g IV every 12 hours for 10 days 1
All doses should be administered intravenously over approximately 30 minutes 1
Clinical Efficacy Evidence
Cefepime demonstrates excellent clinical outcomes in UTI treatment, with clinical cure rates of 94% and pathogen eradication rates of 93% in hospitalized patients with moderate to severe bacterial infections 2. In patients with UTI-associated bacteremia, clinical cure reached 97% with 94% pathogen eradication 2.
Recent high-quality evidence shows cefepime-based combinations (cefepime/enmetazobactam) achieved 79.1% overall treatment success compared to 58.9% with piperacillin/tazobactam in complicated UTI and acute pyelonephritis, demonstrating both noninferiority and superiority 3. Similarly, cefepime/taniborbactam showed 70.6% composite success versus 58.0% with meropenem in complicated UTI populations 4.
Role in Resistant Organisms
Cefepime is a fourth-generation cephalosporin with broader spectrum activity than third-generation agents and is effective against AmpC-producing organisms 5. This makes it particularly valuable when third-generation cephalosporins are not recommended due to resistance concerns 5.
Key Resistance Considerations:
Fourth-generation cephalosporins can be used if Extended-Spectrum beta-lactamase (ESBL) is absent 5
For ESBL-producing organisms, evidence is mixed: some studies show higher mortality with cefepime for ESBL infections, while no difference was found for AmpC producers 5
When cefepime MIC is elevated within the susceptible range (particularly ≥2 mg/L), carbapenems may be preferred 5
Cefepime lacks anti-anaerobic activity and should be combined with metronidazole for empiric therapy in mixed infections 5
Clinical Pearls and Caveats
Important limitations to recognize:
Cefepime is not appropriate as sole therapy for Pseudomonas aeruginosa infections without susceptibility confirmation, though it has some anti-pseudomonal activity 5, 1
First and second-generation cephalosporins are generally not effective against Enterobacter infections, but cefepime's fourth-generation status overcomes this limitation 5
Local resistance patterns should guide empiric selection, and urine culture should be obtained before initiating therapy for complicated UTIs 6
The twice-daily dosing schedule (for mild-moderate infections) offers practical advantages over more frequent dosing regimens 2
Treatment Duration
Standard treatment duration is 7-10 days for most UTIs, with extension to 14 days for delayed clinical response or when prostatitis cannot be excluded in male patients 6, 1. For patients with bacteremia, duration may be extended up to 14 days 1, 4.
Safety Profile
Cefepime is well-tolerated with treatment discontinuation due to adverse events occurring in only 3-5% of patients 2, 3. The most common adverse events include headache, diarrhea, constipation, hypertension, and nausea, with serious adverse events comparable to other beta-lactams 4, 3.