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cefepime (Maxipime)
Tradename: Maxipime. 4th generation cephalosporin.
Indications:
1) broad spectrum coverage for severe to moderate bacterial infections
- pneumonia
- intra-abdominal infection
- urinary tract infection
2) infections caused by Pseudomonas aeruginosa
3) empiric treatment of febrile neutropenia (alone or in combination)
Contraindications:
- use in conjunction with aminoglycoside for serious gram negative infection
Dosage: 0.5-2 g IV/IM every 12 hours.
Pharmacokinetics:
1) penetrate most tissues, including CSF
2) 80% eliminated in urine
3) 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
Antimicrobial activity:
Gram positive (greater gram positive activity than ceftazidime)
- Streptococcus
- Streptococcus group A
- Streptococcus group B
- Streptococcus group C
- Streptococcus group G
- Streptococcus pneumonia
- Streptococcus viridans
- Streptococcus milleri
- Staphylococcus aureus (MSSA)
- Staphylococcus epidermidis (+/-)
Gram negative
- 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
Anaerobes
- Peptostreptococcus species
- Bacteroides [7]
Adverse effects: (also see cephalosporin)
1) local reactions (3%)
a) phlebitis (1.3%)
b) pain/inflammation (0.6%)
c) rash (1.1%)
2) systemic effects (0.1-1%)
- colitis, diarrhea, fever, headache, nausea, vomiting, oral moniliasis, pruritus, urticaria, vaginitis
3) common adverse laboratory changes (> 1%)
a) positive Coomb's test (16%)
b) decreased phosphorous (3%)
c) increased serum transaminases (2.4%)
d) eosinophilia (2%)
e) abnormal PT/PTT (1.5%)
4) less common adverse laboratory changes (0.1-1%)
1) increases in:
- alkaline phosphatase, BUN, calcium, creatinine, phosphorous, K+, total bilirubin
2) decreases in:
- calcium, hematocrit, neutrophils, platelets, WBC
5) 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]
6) risk of acute kidney injury similar to piperacillin-tazobactam [9]
7) no risk of death [5], FDA safety evaluation 2007-2009
Drug interactions:
1) may potentiate nephrotoxicity & ototoxicity of aminoglycosides
2) nephrotoxicity may occur when used in conjunction with loop diuretics (furosemide)
Test interactions:
- may give false positive urine glucose when using Clinitest tablets
Mechanism of action:
- inhibition of bacterial wall synthesis, bactericidal
Interactions
drug interactions
drug adverse effects of cephalosporins
General
cephalosporin, 4th generation
Properties
SIZE: MW = 529.5 G/M
MISC-INFO: elimination route KIDNEY
1/2life 2 HOURS
pregnancy-category B
safety in lactation ?
Database Correlations
PUBCHEM correlations
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
- 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: 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
- 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
- Deprecated Reference
- Geriatric Review Syllabus, 11th edition (GRS11)
Harper GM, Lyons WL, Potter JF (eds)
American Geriatrics Society, 2022
- 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: 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: 37837650
https://jamanetwork.com/journals/jama/fullarticle/2810593
- Medical Knowledge Self Assessment Program (MKSAP) 19
Board Basics. An Enhancement to MKSAP19.
American College of Physicians, Philadelphia 2022
Component-of
cefepime/enmetazobactam (Exblifep)