Is cefepime (Cefepime) effective for treating meningitis?

From the Guidelines

Cefepime can be used for treating meningitis, particularly when caused by susceptible gram-negative bacteria, but it is not the first-line treatment according to the most recent guidelines 1. The most recent and highest quality study, published in 2017, does not recommend cefepime as a first-line treatment for community-acquired bacterial meningitis 1. Instead, the guidelines recommend cefotaxime or ceftriaxone plus vancomycin or rifampicin as the standard treatment for community-acquired bacterial meningitis in adults and children over 1 month old 1. However, cefepime may be considered as an alternative treatment option in certain cases, such as hospital-acquired or gram-negative meningitis, including Pseudomonas aeruginosa infections 1. For adults with bacterial meningitis, the typical dosage of cefepime is 2 grams administered intravenously every 8 hours, while children typically receive 50 mg/kg every 8 hours 1. It is essential to note that cefepime should not be used as monotherapy for community-acquired meningitis where Streptococcus pneumoniae may be present, as some strains can be resistant, and it should be combined with vancomycin until culture results are available 1. Patients with renal impairment require dose adjustments, and common side effects include rash, diarrhea, and potential for C. difficile infection 1. Cefepime works by binding to penicillin-binding proteins, disrupting bacterial cell wall synthesis and causing cell death. Some key points to consider when using cefepime for meningitis include:

• Cefepime is a fourth-generation cephalosporin that penetrates well into the cerebrospinal fluid, making it effective for central nervous system infections.
• The duration of therapy is usually 10-14 days, depending on the causative organism and clinical response.
• Cefepime is particularly useful for hospital-acquired or gram-negative meningitis, including Pseudomonas aeruginosa infections.
• Patients with renal impairment require dose adjustments.
• Common side effects include rash, diarrhea, and potential for C. difficile infection.

From the FDA Drug Label

IN THOSE PATIENTS IN WHOM MENINGEAL SEEDING FROM A DISTANT INFECTION SITE OR IN WHOM MENINGITIS IS SUSPECTED OR DOCUMENTED, AN ALTERNATE AGENT WITH DEMONSTRATED CLINICAL EFFICACY IN THIS SETTING SHOULD BE USED.

• Cefepime is not recommended for the treatment of meningitis.
• The FDA drug label advises using an alternate agent with demonstrated clinical efficacy in this setting. 2

From the Research

Cefepime for Meningitis

• Cefepime can be used for the empiric treatment of meningitis in children, with a 75% cure rate reported in studies 3.
• The efficacy of cefepime in treating bacterial meningitis is comparable to that of cefotaxime and ceftriaxone, with similar clinical response and bacteriologic eradication rates 3, 4.
• Cefepime has been shown to be effective against common pathogens causing meningitis, including Haemophilus influenzae, Neisseria meningitidis, and Streptococcus pneumoniae 3, 4.
• The use of cefepime in adults with meningitis is not well-studied, but it may be considered as an alternative to other cephalosporins in certain cases.
• Cefepime has been found to be safe and well-tolerated in children, with no specific safety concerns identified in studies 3, 4.

Comparison with Other Cephalosporins

• Ceftriaxone and cefotaxime are also effective in treating bacterial meningitis, with similar efficacy to cefepime 5, 6, 7.
• Ceftriaxone offers an advantage in terms of administration, as it can be given as a single daily dose 6.
• Cefotaxime and ceftriaxone have been shown to be effective in treating meningitis caused by a range of pathogens, including Escherichia coli, group B streptococci, and Listeria monocytogenes 5, 7.

Limitations and Considerations

• The use of cefepime in neonates is not well-studied, and it is not recommended in this age group due to concerns about bilirubin displacement 5.
• The efficacy of cefepime in treating meningitis caused by certain pathogens, such as Enterobacter spp. and Serratia marcescens, is not well-established 7.
• The use of cefepime in adults with meningitis should be guided by susceptibility patterns and clinical experience, as the evidence base is limited.