II. Indications
- Conditions
- Complicated Urinary Tract Infection
- Intraabdominal infection
- Pseudomonas infections
- Pneumonia
- Meningitis
- Organisms Covered
- Broad spectrum Gram-positive and Gram-negative organisms (building on Third Generation Cephalosporin coverage)
- Beta-Lactamase resistant organisms
- More AmpB beta lactamase resistant than second and Third Generation Cephalosporins
- Better activity against Citrobacter and Enterobacter
- Pseudomonas coverage (similar to Ceftazidime)
- Although some anaerobic coverage, not active against Bacteroides fragilis
- Use with Metronidazole for intraabdominal infections
III. Mechanism
- Semisynthetic, broad-spectrum, fourth-generation Cephalosporin
IV. Dosing
- Background
- Renal excretion
- Pregnancy Category B
- Safe in Lactation
- Adult (or child weight >40 kg)
- Low Dose (e.g. Mild to moderate severity Urinary Tract Infections)
- Dose: 0.5 to 1 g IM/IV every 12 hours
- Moderate Dose (e.g. Pneumonia)
- Dose: 1 to 2 g IV every 12 hours
- High Dose (e.g. severe Skin and Soft Tissue Infections, UTI, intraabdominal infections)
- Dose: 2 g IV every 12 hours
- Very High Dose (Febrile Neutropenia, Pseudomonas Osteochondritis, Meningitis)
- Dose: 2 g IV every 8 hours
- Low Dose (e.g. Mild to moderate severity Urinary Tract Infections)
- Child (weight <40 kg)
- Moderate Dose (e.g. Skin and Soft Tissue Infections, UTI, Pneumonia)
- Dose: 50 mg/kg IV every 12 hours (up to total daily dose of 4 grams/day)
- High Dose (e.g. Meningitis, Cystic Fibrosis, severe infections)
- Dose: 50 mg/kg IV every 8 hours (up to total daily dose of 6 grams/day)
- Moderate Dose (e.g. Skin and Soft Tissue Infections, UTI, Pneumonia)
- Adult Renal Dosing
- Creatinine Clearance 30 to 60 ml/min
- Dose: 500 to 2000 mg every 24 hours
- Febrile Neutropenia: 2 g every 12 hours
- Creatinine Clearance 11 to 29 ml/min
- Dose: 500 to 1000 mg every 24 hours
- Febrile Neutropenia: 2 g every 24 hours
- Creatinine Clearance <11 ml/min
- Dose: 250 to 500 mg every 24 hours
- Febrile Neutropenia: 1 g every 24 hours
- Hemodialysis
- Administer after Hemodialysis
- Dose: 1 g IV on day 1, then 500 mg every 24 hours
- Febrile Neutropenia: 1 g every 24 hours
- Creatinine Clearance 30 to 60 ml/min
V. Adverse Effects
- CNS Toxicity (including Seizures)
- Increased risk with renal dysfunction
VI. Safety
- Pregnancy Category B
- Safe in Lactation
VII. Resources
- Cefepime (Global RPH)
- Cefepime (DailyMed)
VIII. References
- Hamilton (2020) Tarascon Pharmacopeia, Jones and Bartlett
- (2012) Presc Lett, Resource #280706, Comparison of Cephalosporins