Cefepime-Enmetazobactam

Aka: Cefepime-Enmetazobactam, Cefepime/Enmetazobactam

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II. Background

  1. FDA approved in U.S. in 2024

III. Indications

  1. Conditions
    1. Complicated Urinary Tract Infections including Pyelonephritis (FDA approved)
    2. Hospital Acquired Pneumonia (off-label in U.S., approved in Europe)
    3. Extended-Spectrum Beta-Lactamase Producing Enterobacteriaceae (ESBL)
      1. Alternative to Carbapenems
  2. Bacteria: Complicated gram-negative infections
    1. Escherichia coli
    2. Klebsiella Pneumoniae
    3. Proteus Mirabilis
    4. Pseudomonas Aeruginosa
    5. Enterobacter cloacae

IV. Mechanism

  1. See Cefepime

V. Medications

  1. Cefepime
    1. Fourth Generation Cephalosporin
  2. Enmetazobactam
    1. Beta-Lactamase inhibitor

VI. Dosing

  1. Cefepime/Enmetazobactam 2.5 g IV infused over 2 hours every 8 hours for 7-14 days
  2. Renal Dosing
    1. Reduced dose in eGFR <60 ml/min and Hemodialysis

VII. Adverse Effects

  1. Elevated Liver Function Tests (including transaminases, Serum Bilirubin)
  2. Headache
  3. Gastrointestinal symptoms (Diarrhea, Nausea, Vomiting)
  4. Neurotoxicity (Seizures, encephalopathy)
    1. Higher risk in renal disease
  5. Nephrotoxicity
    1. Higher risk when combined with Aminoglycosides or Loop Diuretics

VIII. Drug Interactions

  1. No major CYP450 or P-Glycoprotein transporter interactions

IX. Safety

  1. Unknown safety in pregnancy
  2. Unknown safety in Lactation
    1. Low level excretion into Breast Milk

X. References

  1. LoVecchio (2025) Crit Dec Emerg Med 39(8): 42

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