cefepime (Maxipime)
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Introduction
Tradename: Maxipime. 4th generation cephalosporin.
Indications
- broad spectrum coverage for severe to moderate bacterial infections
- infections caused by Pseudomonas aeruginosa
- empiric treatment of febrile neutropenia (alone or in combination)
Contraindications
- use in conjunction with aminoglycoside for serious gram negative infection
Dosage
Pharmacokinetics
- penetrate most tissues, including CSF
- 80% eliminated in urine
- 1/2life 2 hours (18 hours ESRD) Dose adjustment in renal failure:
| Creatinine clearance | Dose |
|---|---|
| > 60 mL/min | 1 g IV/IM every 12 hours |
| 30-59 mL/min | 1-2 g IV/IM every 24 hours |
| 10-29 mL/min | 1 g IV/IM every 24 hours |
| >10 mL/min | 0.5 g IV/IM every 24 hours |
elimination via kidney
1/2life = 2 hours
Antimicrobial activity
Gram positive (greater gram positive activity than ceftazidime)
- Neisseria gonorrhoeae
- Neisseria meningitidis
- Moraxella catarrhalis
- Haemophilus influenzae
- Escherichia coli
- Klebsiella species
- Enterobacter species
- Serratia species
- Salmonella species
- Shigella species
- Proteus mirabilis
- Proteus vulgaris
- Providencia species
- Morganella species
- Citrobacter freundii
- Citrobacter diversus
- Citrobacter species
- Aeromonas species
- Acinetobacter species (+/-)
- Pseudomonas aeruginosa
- Pseudomonas cepacia (+/-)
- Yersinia enterocolitica
Adverse effects
(also see cephalosporin)
- local reactions (3%)
- phlebitis (1.3%)
- pain/inflammation (0.6%)
- rash (1.1%)
- systemic effects (0.1-1%)
- common adverse laboratory changes (> 1%)
- positive Coomb's test (16%)
- decreased phosphorous (3%)
- increased serum transaminases (2.4%)
- eosinophilia (2%)
- abnormal PT/PTT (1.5%)
- less common adverse laboratory changes (0.1-1%)
- increases in:
- decreases in:
- neurologic
- cefepime can provoke seizures
- encephalopathy, non-convulsive status epilepticus unless dose adjusted for renal failure[6]
- neurotoxicity associated with a reduced level of consciousness & myoclonus esp with renal failure[8]
- onset of neurotoxicity is 4 days into treatment[8]
- case report of tonic-clonic seizure with post-ictal state in middle-age man with normal renal function after 2 days of cefepime[10]
- more neurologic dysfunction than piperacillin-tazobactam[9]
- cefepime can provoke seizures
- risk of acute kidney injury similar to piperacillin-tazobactam[9]
- no risk of death[5], FDA safety evaluation 2007-2009
Drug interactions
- may potentiate nephrotoxicity & ototoxicity of aminoglycosides
- nephrotoxicity may occur when used in conjunction with loop diuretics (furosemide)
- drug interaction(s) anticonvulsants with anti-bacterial agents
- drug interaction(s) of antibiotics with warfarin
Test interactions
- may give false positive urine glucose when using Clinitest tablets
Mechanism of action
- inhibition of bacterial wall synthesis, bactericidal
More general terms
Component of
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Sanford Guide to antimicrobial therapy 1997
- ↑ Bristol-Myers Squibb Package insert.
- ↑ Department of Veterans Affairs, VA National Formulary
- ↑ 5.0 5.1 Yahav D et al Efficacy and safety of cefepime: a systematic review and meta-analysis The Lancet Infectious Diseases 2007, 7(5):338-348 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17448937 doi:10.1016/S1473-3099(07)70109-3
FDA MedWatch http://www.fda.gov/medwatch/safety/2007/safety07.htm#Cefepime - FDA MedWatch
Cefepime (marketed as Maxipime) Update of Ongoing Safety Review http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm167427.htm - ↑ 6.0 6.1 FDA MedWatch: 6/26/2012 Cefepime:Label Change- Risk of Seizure in Patients Not Receiving Dosage Adjustments for Kidney Impairment http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm309822.htm
FDA Safety Alert: 6/26/2012 FDA Drug Safety Communication: Cefepime and risk of seizure in patients not receiving dosage adjustments for kidney impairment http://www.fda.gov/Drugs/DrugSafety/ucm309661.htm - ↑ 7.0 7.1 Deprecated Reference
- ↑ 8.0 8.1 8.2 Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
- ↑ 9.0 9.1 9.2 Qian ET, Casey JD, Wright A et al Cefepime vs Piperacillin-Tazobactam in Adults Hospitalized With Acute Infection. The ACORN Randomized Clinical Trial/. JAMA. Published online October 14, 2023 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37837651 https://jamanetwork.com/journals/jama/fullarticle/2810592
Tong SYC et al. Acute kidney injury with empirical antibiotics for sepsis. JAMA. 2023;330(16):1531-1533. Oct 14 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37837650 https://jamanetwork.com/journals/jama/fullarticle/2810593 - ↑ 10.0 10.1 Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
Database
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=68606
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=71343
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=2622
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=3072782
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=176055
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=2623