Does Cefepime Have Good Coverage for Pneumonia?
Yes, cefepime provides excellent coverage for pneumonia, including both community-acquired and hospital-acquired pneumonia, with particularly strong activity against Pseudomonas aeruginosa and other gram-negative pathogens while maintaining good gram-positive coverage including Streptococcus pneumoniae. 1
FDA-Approved Indication
Cefepime is FDA-approved for moderate to severe pneumonia caused by Streptococcus pneumoniae (including bacteremic cases), Pseudomonas aeruginosa, Klebsiella pneumoniae, and Enterobacter species. 1 The standard dosing is 1-2g IV every 8-12 hours, with 2g every 8 hours recommended specifically for Pseudomonas aeruginosa infections. 1
Guideline-Recommended Use by Pneumonia Type
Hospital-Acquired and Ventilator-Associated Pneumonia
Cefepime is a first-line recommended agent for empiric treatment of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). 2
- For patients with low mortality risk and no MRSA risk factors: cefepime, piperacillin-tazobactam, levofloxacin, or a carbapenem are all appropriate first choices 2
- For patients with high mortality risk or recent IV antibiotic use within 90 days: cefepime should be used as part of double antipseudomonal coverage (two different classes active against P. aeruginosa) 2
- When Pseudomonas coverage is needed, cefepime is explicitly listed alongside piperacillin-tazobactam, ceftazidime, meropenem, and carbapenems 2
Community-Acquired Pneumonia (Severe)
For severe CAP requiring ICU admission without Pseudomonas risk factors, cefepime is not the preferred agent—non-antipseudomonal third-generation cephalosporins (ceftriaxone, cefotaxime) plus a macrolide are recommended instead. 2
However, for severe CAP with Pseudomonas risk factors (structural lung disease, recent broad-spectrum antibiotics, bronchiectasis), cefepime becomes an appropriate choice as an antipseudomonal cephalosporin, combined with either ciprofloxacin OR a macrolide plus aminoglycoside. 2
Neutropenic Fever
Cefepime is FDA-approved as monotherapy for empiric treatment of febrile neutropenic patients, though combination therapy may be needed in high-risk patients (recent bone marrow transplant, hypotension, severe/prolonged neutropenia). 1
For documented Pseudomonas pneumonia in neutropenic patients, cefepime is listed as an appropriate antipseudomonal β-lactam option alongside piperacillin-tazobactam, ceftazidime, and carbapenems. 2
Microbiological Coverage Strengths
Cefepime's unique advantage is its dual activity: gram-positive coverage similar to third-generation cephalosporins (ceftriaxone/cefotaxime) against S. pneumoniae (including penicillin-resistant strains) and S. aureus (MSSA only), combined with gram-negative coverage similar to ceftazidime against P. aeruginosa. 3
- Stability against β-lactamases: Cefepime is stable against many plasmid- and chromosome-mediated β-lactamases and is a poor inducer of AmpC β-lactamases, maintaining activity against Enterobacter species resistant to third-generation cephalosporins 3
- Clinical trial data: Randomized trials demonstrate cefepime monotherapy (1-2g twice daily) has comparable efficacy to ceftazidime, ceftriaxone, and cefotaxime for moderate to severe pneumonia 3, 4, 5
Important Caveats
- No MRSA coverage: If MRSA is suspected (>10-20% prevalence in your unit, or patient has MRSA risk factors), vancomycin or linezolid must be added 2
- No atypical coverage: Cefepime does not cover Legionella, Mycoplasma, or Chlamydophila—add a macrolide or respiratory fluoroquinolone if atypicals are suspected 2
- ECMO patients require loading dose: In patients on ECMO, a 3g loading dose is essential due to significantly increased volume of distribution (2.8-fold increase) 6
- Ceftazidime caveat: Unlike cefepime, ceftazidime has poor activity against S. pneumoniae and must be combined with penicillin G for pneumococcal coverage 2