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. The use of cefepime for UTI treatment is supported by the drug label 1.
- Severe UTIs: cefepime is indicated for severe UTIs caused by Escherichia coli or Klebsiellapneumoniae.
- Mild to moderate UTIs: cefepime is indicated for mild to moderate UTIs caused by Escherichia coli, Klebsiellapneumoniae, or Proteus mirabilis.
From the Research
Cefepime is not the first-line treatment for uncomplicated urinary tract infections (UTIs), but it can be considered for complicated UTIs or when first-line agents are inappropriate due to resistance patterns or patient factors, as supported by the most recent study 2.
Key Points to Consider
- The most recent study 2 from 2021 highlights the importance of following guidelines for the treatment of uncomplicated UTIs, which recommend nitrofurantoin, trimethoprim-sulfamethoxazole, and Fosfomycin as first-line treatments.
- Cefepime, a fourth-generation cephalosporin, has broad-spectrum activity against both gram-negative and gram-positive bacteria, including Pseudomonas aeruginosa and extended-spectrum beta-lactamase (ESBL) producing organisms, making it effective for complicated UTIs or when first-line agents are not suitable 3.
- The typical adult dosage of cefepime for complicated UTIs is 1-2 grams intravenously every 12 hours for 7-14 days, depending on infection severity, with dose adjustments necessary for patients with renal impairment.
- Potential side effects of cefepime include diarrhea, rash, and rarely neurotoxicity, especially in patients with renal impairment, as noted in various studies 4, 5.
- It is essential to obtain appropriate cultures before initiating therapy when possible to ensure the most effective treatment and minimize the risk of antibiotic resistance.
Considerations for Treatment
- For uncomplicated UTIs, first-line agents like nitrofurantoin, trimethoprim-sulfamethoxazole, or Fosfomycin should be considered before cefepime, based on the guidelines and the study from 2021 2.
- In cases of complicated UTIs or when first-line agents are not appropriate, cefepime can be a viable option due to its broad-spectrum activity, as indicated in the study from 2001 3.
- The choice of antibiotic should always consider the patient's specific situation, including any underlying health conditions, potential allergies, and local resistance patterns, as emphasized in the study from 1999 5.