cefepime, Maxipime

 Indications

Treatment of the following infections caused by susceptible

organisms: Uncomplicated skin and skin structure

infections, Bone and joint infections, Uncomplicated

and complicated urinary tract infections, Respiratory

tract infections, Complicated intra-abdominal infections

(with metronidazole), Septicemia. Empiric treatment of

febrile neutropenic patients.

Action

Binds to the bacterial cell wall membrane, causing cell

death. Therapeutic Effects: Bactericidal action

against susceptible bacteria. Spectrum: Similar to

that of second- and third-generation cephalosporins,

but activity against staphylococci is less, whereas activity

against gram-negative pathogens is greater, even for

organisms resistant to first-, second-, and third-generation

agents. Notable is increased action against: Enterobacter,

Haemophilus influenzae (including-lactamase-

producing strains), Escherichia coli, Klebsiella

pneumoniae, Neisseria, Proteus, Providencia, Pseudomonas

aeruginosa, Serratia, Moraxella catarrhalis(

including-lactamase-producing strains). Not

active against methicillin-resistant staphylococci or enterococci.

Pharmacokinetics

Absorption: Well absorbed after IM administration;

IV administration results in complete bioavailability.

Distribution: Widely distributed. Crosses the placenta;

enters breast milk in low concentrations. Some

CSF penetration.

Protein Binding: 20%.

Metabolism and Excretion: 85% excreted unchanged

in urine.

Half-life: Adults—2 hr (qin renal impairment);

Children 2 mo–6 yr—1.7–1.9 hr.

TIME/ACTION PROFILE

ROUTE ONSET PEAK DURATION

IM rapid 1–2 hr 12 hr

IV rapid end of infusion

12 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity to cephalosporins;

Serious hypersensitivity to penicillins.

Use Cautiously in: Renal impairment (pdosing/q

dosing interval recommended if CCr 60 mL/min); History

of GI disease, especially colitis; Patients with hepatic

dysfunction or poor nutritional status (may be at

qrisk of bleeding); Geriatric patients (dose adjustment

due to age-relatedpin renal function may be necessary);

OB, Lactation: Pregnancy and lactation (safety

not established).

Adverse Reactions/Side Effects

CNS: ENCEPHALOPATHY, SEIZURES (qrisk in renal impairment),

aphasia, headache. GI: CLOSTRIDIUM DIFFICILE-

ASSOCIATED DIARRHEA (CDAD), diarrhea, nausea,

vomiting. Derm: rashes, pruritis, urticaria. Hemat:

bleeding, eosinophilia, hemolytic anemia, neutropenia,

thrombocytopenia. Local: pain at IM site, phlebitis at

IV site. Misc: allergic reactions including ANAPHYLAXIS,

superinfection, fever.

Interactions

Drug-Drug: Probenecidpexcretion andqblood

levels. Concurrent use of loop diuretics or aminoglycosides

mayqrisk of nephrotoxicity.

Route/Dosage

IM (Adults): Mild-to-moderate uncomplicated or

complicated urinary tract infections due to Escherichia

coli—0.5–1 g every 12 hr.

IV (Adults): Moderate-to-severe pneumonia—1–2

g every 12 hr. Mild-to-moderate uncomplicated or

complicated urinary tract infections—0.5–1 g

every 12 hr. Severe uncomplicated or complicated

urinary tract infections, moderate-to-severe uncomplicated

skin and skin structure infections,

complicated intra-abdominal infections—2 g every

12 hr. Empiric treatment of febrile neutropenia—2

g every 8 hr.

IV (Children 1 mo–16 yr): Uncomplicated and

complicated urinary tract infections, uncomplicated

skin and skin structure infections, pneumonia—50

mg/kg every 12 hr (not to exceed 2 g/dose). Febrile

neutropenia—50 mg/kg every 8 hr (not to exceed 2

g/dose).

IV (Neonates postnatal age 14 days): 50 mg/kg

every 12 hr.

IV (Neonates postnatal age 14 days): 30 mg/kg

every 12 hr; consider 50 mg/kg every 12 hr for Pseudomonas

infections.

Renal Impairment

IM, IV (Adults): (See Manufacturer’s specific recommendations)

CCr 30–60 mL/min—0.5–1 g every 24

hr or 2 g every 12–24 hr; CCr 11–29 mL/min—0.5–

2 g every 24 hr; CCr 11 mL/min—250 mg–1 g

every 24 hr.

Availability (generic available)

Powder for injection: 500 mg, 1 g, 2 g. Premixed

containers: 1 g/50 mL D5W, 2 g/100 mL D5W.