From the Guidelines
Cefepime is not recommended for oral (PO) administration in urinary tract infections (UTIs) as it is only available in intravenous (IV) or intramuscular (IM) formulations. For UTIs requiring outpatient treatment, appropriate oral antibiotics include nitrofurantoin, trimethoprim-sulfamethoxazole, fosfomycin, or oral fluoroquinolones like ciprofloxacin depending on local resistance patterns and patient factors.
Key Considerations
- For uncomplicated cystitis, typical regimens include nitrofurantoin 100mg twice daily for 5 days, trimethoprim-sulfamethoxazole 160/800mg twice daily for 3 days, or fosfomycin 3g single dose, as recommended by the American College of Physicians 1.
- For complicated UTIs or pyelonephritis, longer courses (7-14 days) are needed, and the choice of antibiotic should be guided by the severity of the infection and local resistance patterns.
- If a patient requires a cephalosporin, oral options include cephalexin, cefuroxime, or cefdinir, but cefepime is reserved for parenteral use in more severe infections when broader gram-negative coverage is needed, particularly for hospital-acquired infections or in patients with risk factors for resistant organisms, as suggested by the European Association of Urology guidelines 1.
Spectrum of Activity
- Cefepime's spectrum includes Pseudomonas aeruginosa and many extended-spectrum beta-lactamase (ESBL) producing organisms, but this broad coverage is rarely necessary for community-acquired UTIs.
Treatment Recommendations
- The Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases recommend against using amoxicillin or ampicillin for empirical treatment of UTIs due to high resistance rates 1.
- The European Association of Urology guidelines recommend using a combination of antibiotics, such as amoxicillin plus an aminoglycoside, or a second-generation cephalosporin plus an aminoglycoside, for complicated UTIs with systemic symptoms 1.
From the FDA Drug Label
The safety and effectiveness of cefepime in the treatment of uncomplicated and complicated urinary tract infections (including pyelonephritis) have been established
- Cefepime can be used for the treatment of urinary tract infections (UTIs), including both uncomplicated and complicated cases, as well as pyelonephritis.
- The use of cefepime for injection in patients with UTIs is supported by evidence from adequate and well-controlled studies in adults, with additional pharmacokinetic and safety data from pediatric trials 2.
- However, it is essential to note that cefepime is typically administered intravenously, and its use in the form of PO (oral) for UTI treatment is not directly addressed in the provided drug label.
From the Research
Cefepime for UTI Treatment
- Cefepime is a fourth-generation cephalosporin that has been studied for the treatment of urinary tract infections (UTIs) 3.
- It has been shown to be effective in treating both complicated and uncomplicated UTIs, including those caused by antibiotic-resistant bacteria 4, 3.
- Cefepime has a broad spectrum of activity and is suitable for use as an empiric agent in most cases of UTI 5.
Oral Cefepime for UTI
- There is limited information available on the use of oral cefepime for UTI treatment. However, cefepime is typically administered intravenously or intramuscularly 3, 6.
- Other oral cephalosporins, such as cephalexin and cefixime, have been studied for UTI treatment and have shown efficacy 5, 7.
Treatment Options for UTI
- The recommended first-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis includes nitrofurantoin, fosfomycin tromethamine, or pivmecillinam 4.
- Second-line options include oral cephalosporins, such as cephalexin or cefixime, fluoroquinolones, and β-lactams, such as amoxicillin-clavulanate 4.
- Cefepime is considered a treatment option for UTIs caused by multidrug-resistant (MDR) organisms, including MDR-Pseudomonas spp. 4.