From the Guidelines
Cefepime is effective for treating infections in patients with obstructive nephropathy (ONA), and its use is recommended as part of empiric therapy for fever and neutropenia, particularly in high-risk patients. According to the most recent guidelines, cefepime can be used as monotherapy or in combination with other antibiotics, such as aminoglycosides or vancomycin, depending on the patient's risk factors and local epidemiology 1. The choice of cefepime should be based on its broad-spectrum activity against both gram-positive and gram-negative bacteria, including Pseudomonas aeruginosa, which is a common cause of infections in patients with ONA.
Some key points to consider when using cefepime in patients with ONA include:
- Cefepime has been shown to be effective against a wide range of gram-negative bacteria, including Pseudomonas aeruginosa, which is a common cause of infections in patients with ONA 1.
- The use of cefepime as monotherapy or in combination with other antibiotics, such as aminoglycosides or vancomycin, should be based on the patient's risk factors and local epidemiology 1.
- Cefepime is primarily eliminated through the kidneys, which explains why dosage adjustments are crucial in patients with compromised renal function to prevent drug accumulation and potential neurotoxicity while maintaining therapeutic efficacy 1.
- Regular monitoring of kidney function is necessary during treatment with cefepime, as ONA can cause fluctuating renal function.
In terms of specific dosing recommendations, the use of cefepime with modified dosing is recommended for patients with ONA, with adjustments based on kidney function. For example, for mild to moderate kidney impairment (creatinine clearance 30-60 mL/min), use 1-2g every 12-24 hours; for severe impairment (creatinine clearance 10-30 mL/min), use 1g every 24 hours; and for end-stage renal disease, use 500mg-1g every 24 hours 1. However, it's essential to note that these recommendations may vary depending on the specific clinical context and local guidelines.
From the FDA Drug Label
Cefepime for injection, USP is indicated in the treatment of the following infections caused by susceptible strains of the designated microorganisms The FDA drug label does not answer the question.
From the Research
Cefepime's Effectiveness
- Cefepime is a potent, broad-spectrum, fourth-generation cephalosporin with enhanced activity against most gram-positive aerobic bacterial pathogens and many gram-negative aerobic bacteria that are resistant to other cephalosporins 2.
- It has a good toxicity profile, with minor gastrointestinal and central nervous system symptoms being most prevalent 2.
- Cefepime is an alternative option for infections of the lower respiratory tract, urinary tract, and skin and skin structures, as well as febrile episodes in neutropenic patients with cancer, and bacteremia or septicemia in critically ill patients 2.
Comparative Trials
- In comparative trials, cefepime 1 to 2 g, usually administered intravenously twice daily, was as effective as ceftazidime 1 to 2 g, usually administered 3 times daily, for treatment of bacteraemia and infections of the lower respiratory tract, urinary tract, pelvis and skin and skin structures 3.
- Cefepime was as effective as ceftazidime and piperacillin or mezlocillin in combination with gentamicin when administered as empirical treatment for fever in patients with neutropenia 3.
- A limited number of trials have found cefepime to be as effective as cefotaxime for the treatment of gynaecological and lower respiratory tract infections 3.
Pharmacokinetics and Tolerability
- Cefepime has a linear pharmacokinetic profile, an elimination half-life of approximately 2 hours and is primarily excreted by renal mechanisms as unchanged drug 3.
- Cefepime has a tolerability profile similar to that of other parenteral cephalosporins; adverse events are primarily gastrointestinal in nature 3.
- A total of 1.4 and 2.9% of patients receiving cefepime < or = 2 g/day and > 2 g/day, respectively, required treatment withdrawal as a result of any adverse event 3.
Future Role
- Cefepime, a wide-spectrum β-lactam antibiotic, has been in use for the treatment of serious bacterial infections for almost 25 years, and its future role in combination with novel β-lactamase inhibitors for MDR Enterobacterales and Pseudomonas aeruginosa is being studied 4.
- There are currently four new cefepime/BLI combinations in clinical development, including cefepime/zidebactam, cefepime/taniborbactam, cefepime/enmetazobactam, and cefepime/tazobactam 4.