Cefepime


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : IM/IV Susceptible infections Mild to moderate: 1-2 g/day in 2 divided doses. Severe: Up to 4 g/day in 2 divided doses. Empirical therapy for febrile neutropenia Up to 6 g/day in 3 divided doses.
Dosage Details
Parenteral
Abdominal infections, Respiratory tract infections, Skin and skin structure infections, Urinary tract infections
Adult: Mild to moderate infections: 1-2 g daily in 2 divided doses. Severe infections: Up to 4 g daily in 2 divided doses. Doses are given by deep IM inj or IV infusion over at least 30 min.
Child: Neonates: 30 mg/kg 12 hrly, may increase to 50 mg/kg for Pseudomonas infections; >30 days Mild to moderate infections: 100 mg/kg daily in 2 divided doses. Severe infections: Up to 150 mg/kg daily in 2 or 3 divided doses. Total dose should not exceed the recommended adult dosage.

Parenteral
Empiric therapy for febrile neutropenic patients
Adult: Up to 6 g daily in 3 divided doses. Doses are given by deep IM inj or IV infusion over at least 30 min.
Special Patient Group
Critically ill patients undergoing continuous renal replacement therapy: Loading dose: 2 g. Maintenance dose: Continuous venovenous haemofiltration (CVVH): 1-2 g 12 hrly. Continuous venovenous haemodialysis (CVVHD) and haemodiafiltration (CVVHDF): 1 g 8 hrly or 2 g 12 hrly.
Renal Impairment
Abdominal infections, Urinary tract infections, Respiratory tract infection, Skin and skin structure infections: Haemodialysis: 1 g on the 1st day of treatment, followed by 0.5 g daily; dose given after haemodialysis. CAPD: Adult dose given 48 hrly.
CrCl Dosage
≤10 0.25-0.5 g 24 hrly.
11-29 0.5-1 g 24 hrly.
30-60 0.5-2 g 24 hrly.
Empiric therapy for febrile neutropenic patients: Haemodialysis patients: 1 g daily. CAPD: 2 g 48 hrly.
CrCl Dosage
≤10 1 g 24 hrly.
11-29 2 g 24 hrly.
30-60 2 g 12 hrly.
Reconstitution
IV infusion: Add 5 mL, 10 mL, or 10 mL of a compatible IV soln to a vial labeled as containing 500 mg, 1 g, or 2 g, respectively, to provide soln containing approx 100 mg/mL, 100 mg/mL, or 160 mg/mL of the drug, respectively. The appropriate dose of the drug should then be added to a compatible IV soln. IM inj: Add 1.3 mL or 2.4 mL of an appropriate diluent (e.g. sterile water for inj, NaCl 0.9%) to a vial labeled as containing 500 mg or 1 g respectively, to provide a soln containing approx 280 mg/mL.
Incompatibility
Y-site: Acetylcysteine, aciclovir, amphotericin B, amphotericin B cholesteryl sulfate complex, caspofungin, chlorpromazine, cimetidine, ciprofloxacin, cisplatin, dacarbazine, daunorubicin, diazepam, diphenhydramine, doxorubicin, droperidol, enalaprilat, erythromycin lactobionate, etoposide, etoposide phosphate, famotidine, filgrastim, floxuridine, gallium nitrate, ganciclovir, haloperidol, hydroxyzine, idarubicin, ifosfamide, Mg sulfate, mannitol, mechlorethamine, meperidine, metoclopramide, midazolam, mitomycin, mitoxantrone, morphine, nalbuphine, nicardipine, ondansetron, phenytoin, prochlorperazine edisylate, promethazine, streptozocin, theophylline, vinblastine, vincristine.
Contraindications
Hypersensitivity to cefepime or other cephalosporins.
Special Precautions
Hypersensitivity to penicillins or other β-lactam antibiotics. Patient w/ history of seizure disorder, history of GI disease, particularly colitis. Renal impairment. Pregnancy and lactation. Prolonged use may result in overgrowth of non-susceptible organisms.
Adverse Reactions
Headache, rash, diarrhoea, nausea, vomiting, local reactions (e.g. phlebitis, pain and/or inflammation), neutropenia, positive direct Coombs' test.
Potentially Fatal: Neurotoxicity (e.g. encephalopathy, myoclonus, seizures, non-convulsive status epilepticus); Clostridium difficile-associated diarrhoea; anaphylaxis.
IM/IV/Parenteral: B
MonitoringParameters
Monitor renal function; signs and symptoms of anaphylaxis during 1st dose.
Overdosage
Symptoms: Encephalopathy (disturbance of consciousness including confusion, hallucinations, stupor, and coma), myoclonus, seizures, neuromuscular excitability and non-convulsive status epilepticus. Management: Supportive treatment. Haemodialysis is recommended in case of renal insufficiency.
Drug Interactions
Increased potential for nephrotoxicity and ototoxicity of aminoglycosides. Increased risk of nephrotoxicity w/ potent diuretics (e.g. furosemide).
Lab Interference
False positive reaction for urine glucose test using Clinitest tablets.
Action
Description: Cefepime inhibits bacterial cell wall synthesis by binding to 1 or more of the penicillin-binding proteins (PBPs) which in turn inhibit the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysis and murein hydrolases) while cell wall assembly is arrested.
Pharmacokinetics:
Absorption: Rapidly and almost completely absorbed on IM inj. Time to peak plasma concentration: Approx 1.5 hr (IM); w/in 30 min (IV).
Distribution: Widely distributed in body tissues and fluids; high concentrations in bile. Crosses the blood-brain barrier and enters breast milk (low concentrations). Volume of distribution: 16-20 L. Plasma protein binding: Approx 20%.
Metabolism: Minimally hepatic.
Excretion: Via urine (approx 85% as unchanged drug). Plasma half-life: Approx 2 hr.
Chemical Structure

Chemical Structure Image
Cefepime

Source: National Center for Biotechnology Information. PubChem Database. Cefepime, CID=5479537, https://pubchem.ncbi.nlm.nih.gov/compound/Cefepime (accessed on Jan. 21, 2020)

Storage
Store between 20-25°C. Protect from light.
MIMS Class
References
Anon. Cefepime. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 11/11/2014.

Buckingham R (ed). Cefepime Hydrochloride . Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 11/11/2014.

Cefepime Hydrochloride Injection, Powder, for Solution (Fresenius Kabi USA, LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 11/11/2014.

McEvoy GK, Snow EK, Miller J et al (eds). Cefepime Hydrochloride . AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 11/11/2014.

Disclaimer: This information is independently developed by MIMS based on Cefepime from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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