Is oral cefepime available for patients requiring antibiotic therapy?

Is Oral Cefepime Available?

No, cefepime is not available in an oral formulation—it is only administered intravenously or intramuscularly. 1, 2

Formulation and Administration

• Cefepime is a parenteral fourth-generation cephalosporin that must be given by intravenous or intramuscular injection 1, 2
• The drug is not well absorbed after oral administration, making oral formulations not feasible 3
• Bioavailability following intramuscular injection exceeds 90%, but there is no oral bioavailability 3

Clinical Context: When Oral Alternatives Are Needed

If you need to transition from IV cefepime to oral therapy, the choice depends entirely on the clinical scenario:

For Febrile Neutropenia (Low-Risk Adults)

• Switch to ciprofloxacin plus amoxicillin-clavulanate after 48 hours of IV therapy if the patient was initially low-risk, has become afebrile, and shows no complications 4
• This oral regimen is the most thoroughly evaluated for febrile neutropenia 4

For Febrile Neutropenia (Low-Risk Children)

• Switch to cefixime (not cefepime) after 48 hours of in-hospital IV treatment 4
• Initial empirical oral therapy is not recommended for children with febrile neutropenia 4

For Pediatric Infections Requiring Pseudomonal Coverage

• Use ciprofloxacin 10-20 mg/kg/dose orally every 12 hours (maximum 750 mg/dose) if continued pseudomonal coverage is needed 5

For Beta-Lactamase Producing Organisms

• Use amoxicillin-clavulanate at 45 mg/kg/day in 3 doses or 90 mg/kg/day in 2 doses (of amoxicillin component) 5

Common Pitfalls to Avoid

• Do not assume any cephalosporin has an oral equivalent with the same spectrum—cefixime, for example, has no activity against MRSA, while cefepime does have some activity against methicillin-susceptible strains 5, 1
• Do not switch to oral therapy prematurely—ensure clinical stability with fever resolution and symptom improvement before transitioning 5
• Do not use fluoroquinolones orally if the patient was receiving fluoroquinolone prophylaxis—this increases resistance risk 4
• Verify organism susceptibility before switching—if the organism produces beta-lactamases resistant to oral options, IV therapy may need to continue 5

Why Cefepime Remains IV-Only

Cefepime's pharmacokinetic profile requires parenteral administration to achieve therapeutic concentrations 1, 3. Its elimination half-life is approximately 2 hours, with 80% eliminated unchanged in urine 1, 3. The drug exhibits low protein binding (approximately 10%) and distributes into extracellular fluid, but oral absorption is insufficient for clinical efficacy 3.