Cefepime

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Cefepime Brand Name– Maxipime

What is Cefepime

Cefepime is a parenteral cephalosporin with pharmacokinetics and spectrum of activity similar to ceftazidime, a ‘third-generation’ cephalosporin.

Because cefepime may be active against some organisms resistant to ceftazidime, some consider cefepime a ‘fourth-generation’ cephalosporin.

Cefepime is comparable to ceftazidime in its coverage of Pseudomonas aeruginosa, and it may be more active than ceftazidime against Enterobacter sp. due to enhanced stability against beta-lactamases. Clinical uses of cefepime are similar to those of the third-generation cephalosporins.

Cefepime was approved in January 1996. It was approved for the treatment of febrile neutropenia in June 1997 and for complicated intra-abdominal infections in January 1998. In early 2007, the safety of cefepime relative to other beta-lactam antibiotics was questioned.

A meta-analysis evaluating the efficacy and safety of cefepime reported a higher all-cause mortality in patients treated with cefepime compared to other beta-lactams.

The FDA has conducted additional analyses and determined that the data do not indicate a higher rate of death in cefepime-treated patients.

While the FDA has concluded that cefepime remains an appropriate therapy for its approved indications, they will continue to review its safety.

Indications

  1. Acinetobacter calcoaceticus
  2. Acinetobacter lwoffii
  3. Aeromonas hydrophila
  4. bacteremia
  5. biliary tract infections
  6. cholangitis
  7. cholecystitis
  8. Citrobacter diversus
  9. Citrobacter freundii
  10. community-acquired pneumonia
  11. diabetic foot ulcer
  12. endocarditis
  13. Enterobacter sp.
  14. Escherichia coli
  15. febrile neutropenia
  16. Gardnerella vaginalis
  17. Haemophilus influenzae (beta-lactamase negative)
  18. Haemophilus influenzae (beta-lactamase positive)
  19. Hafnia alvei
  20. intraabdominal infections
  21. Klebsiella oxytoca
  22. Klebsiella pneumoniae
  23. meningitis
  24. Moraxella catarrhalis
  25. Morganella morganii
  26. Neisseria gonorrhoeae
  27. Neisseria meningitidis
  28. nosocomial pneumonia
  29. Pantoea agglomerans
  30. peritonitis
  31. pleural empyema
  32. pneumonia
  33. Proteus mirabilis
  34. Proteus vulgaris
  35. Providencia rettgeri
  36. Providencia stuartii
  37. Pseudomonas aeruginosa
  38. pyelonephritis
  39. Salmonella sp.
  40. sepsis
  41. Serratia liquefaciens
  42. Serratia marcescens
  43. Shigella sp.
  44. skin and skin structure infections
  45. Staphylococcus aureus (MSSA)
  46. Staphylococcus epidermidis
  47. Staphylococcus saprophyticus
  48. Streptococcus agalactiae (group B streptococci)
  49. Streptococcus bovis
  50. Streptococcus pneumoniae
  51. Streptococcus pyogenes (group A beta-hemolytic streptococci)
  52. urinary tract infection (UTI)
  53. Viridans streptococci
  54. Yersinia enterocolitica

Side Effects

  1. agranulocytosis
  2. anaphylactic shock
  3. anaphylactoid reactions
  4. anemia
  5. aphasia
  6. aplastic anemia
  7. azotemia
  8. bleeding
  9. candidiasis
  10. cholestasis
  11. colitis
  12. coma
  13. confusion
  14. diarrhea
  15. elevated hepatic enzymes
  16. encephalopathy
  17. eosinophilia
  18. erythema
  19. erythema multiforme
  20. fever
  21. hallucinations
  22. headache
  23. hemolytic anemia
  24. hypercalcemia
  25. hyperkalemia
  26. hyperphosphatemia
  27. hypocalcemia
  28. hypophosphatemia
  29. hypoprothrombinemia
  30. injection site reaction
  31. leukopenia
  32. nausea
  33. neutropenia
  34. pancytopenia
  35. phlebitis
  36. pruritus
  37. pseudomembranous colitis
  38. rash
  39. seizures
  40. Stevens-Johnson syndrome
  41. superinfection
  42. thrombocytopenia
  43. toxic epidermal necrolysis
  44. urticaria
  45. vaginitis
  46. vomiting

Monitoring Parameters

  • prothrombin time (PT)
  • serum creatinine/BUN

Contraindications

  • breast-feeding
  • cephalosporin hypersensitivity
  • coagulopathy
  • diarrhea
  • geriatric
  • penicillin hypersensitivity
  • pregnancy
  • pseudomembranous colitis
  • renal failure
  • renal impairment
  • vitamin K deficiency

Interactions

  • Amikacin
  • Aminoglycosides
  • Gentamicin
  • Kanamycin
  • Loop diuretics
  • Oral Contraceptives
  • Paromomycin
  • Plazomicin
  • Sodium picosulfate; Magnesium oxide; Anhydrous citric acid
  • Streptomycin
  • Tobramycin
  • Warfarin

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