From the Guidelines
Cefepime is an effective antibiotic for treating pneumonia, particularly in hospitalized patients with moderate to severe infections, with a recommended dose of 1-2 grams intravenously every 8-12 hours. The effectiveness of cefepime in pneumonia is supported by guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia, which recommend cefepime as an antipseudomonal cephalosporin option 1. Cefepime works well against many common pneumonia pathogens, including Streptococcus pneumoniae, Haemophilus influenzae, Pseudomonas aeruginosa, and many Enterobacteriaceae. As a fourth-generation cephalosporin, it has enhanced stability against beta-lactamases and improved penetration through the outer membrane of gram-negative bacteria compared to earlier cephalosporins.
Key Considerations
- Cefepime should not be used as monotherapy if MRSA or atypical pathogens are suspected, and combination therapy with agents like vancomycin (for MRSA) or a macrolide/fluoroquinolone (for atypicals) would be necessary 1.
- Patients should be monitored for potential side effects, including neurotoxicity, which can occur especially in those with renal impairment or when using higher doses.
- The Infectious Diseases Society of America/American Thoracic Society consensus guidelines recommend cefepime as an option for empirical therapy in patients with severe community-acquired pneumonia, particularly when Pseudomonas infection is suspected 1.
Dosing and Administration
- The typical dosing of cefepime is 1-2 grams intravenously every 8-12 hours for 5-7 days.
- Dose adjustments are needed for patients with renal impairment.
- Cefepime can be used in combination with other antibiotics, such as aminoglycosides or fluoroquinolones, to provide broader coverage against potential pathogens.
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 ... Pneumonia (moderate to severe) caused by Streptococcus pneumoniae, including cases associated with concurrent bacteremia, Pseudomonas aeruginosa, Klebsiellapneumoniae, or Enterobacter species.
Cefepime is effective in the treatment of pneumonia (PNA), specifically moderate to severe cases caused by susceptible strains of certain microorganisms, including Streptococcus pneumoniae, Pseudomonas aeruginosa, Klebsiellapneumoniae, or Enterobacter species 2.
- Key points:
- Cefepime is indicated for pneumonia caused by specific susceptible microorganisms
- The drug is effective for moderate to severe pneumonia cases
- It is essential to consider culture and susceptibility information when selecting antibacterial therapy.
From the Research
Cefepime Effectiveness in PNA
- Cefepime is a fourth-generation cephalosporin with a broad spectrum of antibacterial activity, effective against many organisms causative of pneumonia, including Gram-positive and Gram-negative organisms 3.
- Cefepime has been shown to be effective in treating patients with pneumonia, including those with moderate to severe community-acquired or nosocomial pneumonia, with clinical and bacteriological response rates similar to those of other antibiotics such as ceftazidime, ceftriaxone, and cefotaxime 3, 4.
- In patients with Pseudomonas aeruginosa infections undergoing renal replacement therapy, cefepime has been shown to be effective, with a 30-day survival rate of 72.7% and a clinical cure rate of 58.3% 5.
- Cefepime has also been shown to be effective in combination with other antibiotics, such as gentamicin, ciprofloxacin, and levofloxacin, against Pseudomonas aeruginosa 6.
- A study comparing cefepime with other antibiotics in the treatment of gram-negative pulmonary and bloodstream infections found that cefepime was effective, with a treatment failure rate of 48.6% compared to 32.6% for other antibiotics, although this difference was not statistically significant 7.
Mechanism of Action and Resistance
- Cefepime is stable against many common plasmid- and chromosome-mediated beta-lactamases and is a poor inducer of AmpC beta-lactamases, which helps to retain its activity against Enterobacteriaceae that are resistant to third-generation cephalosporins 3.
- However, cefepime may be hydrolyzed by extended-spectrum beta-lactamases produced by some members of the Enterobacteriaceae, although to a lesser extent than third-generation cephalosporins 3.
Clinical Use and Safety
- Cefepime is generally well tolerated, with a tolerability profile similar to that of other parenteral cephalosporins, and the most common adverse events reported in clinical trials include rash, diarrhea, and nausea 3, 4.
- Cefepime may be used as monotherapy or in combination with other antibiotics, and its dosing strategy may be adjusted based on renal function and the severity of the infection 5, 7.