Difference between revisions of "Cefepime"

(Pharmacology)
(Serious)
 
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==General==
 
==General==
 
*Type: Fourth generation [[Cephalosporins|cephalosporin]]
 
*Type: Fourth generation [[Cephalosporins|cephalosporin]]
*Dosage Forms: IV, IM
+
*Dosage Forms: infusion solution, powder for injection
 +
*Dosage Strengths: infusion solution: 1g/50mL, 2g/100mL; powder for injection: 1g, 2g
 +
*Routes of Administration: IV, IM
 
*Common Trade Names: Maxipime
 
*Common Trade Names: Maxipime
  
 
==Adult Dosing==
 
==Adult Dosing==
 
===Bacterial Infections===
 
===Bacterial Infections===
* 1-2 g IV q12H (Max: 6 g/24h; dose, duration varies with infection type, severity)
+
*1-2 g IV q12H (Max: 6 g/24h; dose, duration varies with infection type, severity)
  
 
===Febrile Neutropenia===
 
===Febrile Neutropenia===
* 2g IV q8H
+
*2g IV q8H
  
 
===[[UTI]], mild-moderate===
 
===[[UTI]], mild-moderate===
* 0.5-1g IV/IM q12H x7-10 days (IM only for UTI due to E. coli)
+
*0.5-1g IV/IM q12H x7-10 days (IM only for UTI due to E. coli)
  
 
===[[UTI]], severe===
 
===[[UTI]], severe===
* 2g IV q12H x10 days
+
*2g IV q12H x10 days
  
 
===Renal dosing===
 
===Renal dosing===
* Febrile Neutropenia: CrCl 30-60: 2 g q12H; CrCl 11-29: 2 g q24H; CrCL <11: 2gx1, then 1g q24H; HD: 1g q24H, give after dialysis; PD: 2g q48H
+
*Febrile Neutropenia: CrCl 30-60: 2 g q12H; CrCl 11-29: 2 g q24H; CrCL <11: 2gx1, then 1g q24H; HD: 1g q24H, give after dialysis; PD: 2g q48H
*All other infections: CrCl 30-60: give q24h; CrCl 11-29: give usual dose x1, then 0.5-1 g q24h; CrCl <11: give usual dose x1, then 250-500 mg q24h; HD: 1 g x1, then 500 mg q24h, give after dialysis; PD: give usual dose q48h
+
*All other infections: CrCl 30-60: give q24h; CrCl 11-29: give usual dose x1, then 0.5-1 g q24h; CrCl <11: give usual dose x1, then 250-500mg q24h; HD: 1 g x1, then 500mg q24h, give after dialysis; PD: give usual dose q48h
  
===Hepatic Doseing===
+
===Hepatic Dosing===
* no adjustment
+
*no adjustment
  
 
==Pediatric Dosing==
 
==Pediatric Dosing==
 +
*Mild to moderate infection: 50 mg/kg/dose every 12 hours; maximum dose: 2,000 mg/dose
 +
 +
*Severe infection: 50 mg/kg/dose every 8 to 12 hours; maximum dose: 2,000 mg/dose
  
 
===Bacterial Infections===
 
===Bacterial Infections===
* >2 mo: Dose: 50 mg/kg IV/IM q12h; Max: 2 g/dose; Info: duration varies w/ infection type, severity; IM only for mild-mod. UTI due to E. coli
+
*>2 mo: Dose: 50mg/kg IV/IM q12h; Max: 2 g/dose; Info: duration varies with infection type, severity; IM only for mild-mod. UTI due to E. coli
  
 
===Febrile Neutropenia===
 
===Febrile Neutropenia===
* >2 mo: Dose: 50 mg/kg IV q8h; Max: 2 g/dose
+
*>2 mo: Dose: 50mg/kg IV q8h; Max: 2 g/dose
  
===Respiratory Infections, cystic fibrosis pts===
+
===Respiratory Infections, cystic fibrosis patients===
* >2 mo: Dose: 50 mg/kg IV q8h x2wk; Max: 2 g/dose
+
*>2 mo: Dose: 50mg/kg IV q8h x2wk; Max: 2 g/dose
  
 
===Renal Dosing===
 
===Renal Dosing===
* Febrile Neutropenia, cystic fibrosis: CrCl 30-60: 50 mg/kg q12h; CrCl 11-29: 50 mg/kg q24h; CrCl <11: 50 mg/kg x1, then 25 mg/kg q24h; HD: 25 mg/kg q24h, give after dialysis; PD: 50 mg/kg q48h
+
*Febrile Neutropenia, cystic fibrosis: CrCl 30-60: 50mg/kg q12h; CrCl 11-29: 50mg/kg q24h; CrCl <11: 50mg/kg x1, then 25mg/kg q24h; HD: 25mg/kg q24h, give after dialysis; PD: 50mg/kg q48h
* all other infections: CrCl 30-60: 50 mg/kg q24h; CrCl 11-29: 50 mg/kg x1, then 25-50 mg/kg q24h; CrCl <11: 50 mg/kg x1, then 12.5-25 mg/kg q24h; HD: 50 mg/kg x1, then 25 mg/kg q24h, give after dialysis; PD: 50 mg/kg q48h
+
*all other infections: CrCl 30-60: 50mg/kg q24h; CrCl 11-29: 50mg/kg x1, then 25-50mg/kg q24h; CrCl <11: 50mg/kg x1, then 12.5-25mg/kg q24h; HD: 50mg/kg x1, then 25mg/kg q24h, give after dialysis; PD: 50mg/kg q48h
  
 
===Hepatic Dosing===
 
===Hepatic Dosing===
* No Adjustment
+
*No Adjustment
  
 
==Special Populations==
 
==Special Populations==
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*Lactation: Probably safe
 
*Lactation: Probably safe
 
*Renal Dosing
 
*Renal Dosing
**Adult: CrCl 30-60: give q24h; CrCl 11-29: give usual dose x1, then 0.5-1 g q24h; CrCl <11: give usual dose x1, then 250-500 mg q24h; HD: 1 g x1, then 500 mg q24h, give after dialysis; PD: give usual dose q48h
+
**Adult: CrCl 30-60: give q24h; CrCl 11-29: give usual dose x1, then 0.5-1 g q24h; CrCl <11: give usual dose x1, then 250-500mg q24h; HD: 1 g x1, then 500mg q24h, give after dialysis; PD: give usual dose q48h
**Pediatric: CrCl 30-60: 50 mg/kg q24h; CrCl 11-29: 50 mg/kg x1, then 25-50 mg/kg q24h; CrCl <11: 50 mg/kg x1, then 12.5-25 mg/kg q24h; HD: 50 mg/kg x1, then 25 mg/kg q24h, give after dialysis; PD: 50 mg/kg q48h
+
**Pediatric: CrCl 30-60: 50mg/kg q24h; CrCl 11-29: 50mg/kg x1, then 25-50mg/kg q24h; CrCl <11: 50mg/kg x1, then 12.5-25mg/kg q24h; HD: 50mg/kg x1, then 25mg/kg q24h, give after dialysis; PD: 50mg/kg q48h
 
*Hepatic Dosing
 
*Hepatic Dosing
 
**Adult: No adjustment
 
**Adult: No adjustment
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*Allergy to class/drug (See also [[EBQ:Cephalosporin Cross-reactivity|Cephalosporin Cross-reactivity]]
 
*Allergy to class/drug (See also [[EBQ:Cephalosporin Cross-reactivity|Cephalosporin Cross-reactivity]]
 
*Caution if hypersensitive to PCN
 
*Caution if hypersensitive to PCN
*Caution if recent abx-associated colitis history
+
*Caution if recent antibiotic-associated colitis history
 
*Caution if GI disorder history
 
*Caution if GI disorder history
* caution if H. influenzae infection (peds patients)
+
*caution if H. influenzae infection (pediatric patients)
  
 
==Adverse Reactions==
 
==Adverse Reactions==
 
===Serious===
 
===Serious===
 
*[[Anaphylaxis]]
 
*[[Anaphylaxis]]
*[[Encephalopathy]]
+
*[[Encephalopathy]] (patients with renal insufficiency more prone)
 
*[[Seizures]]
 
*[[Seizures]]
 
*Non-convulsive status epilepticus
 
*Non-convulsive status epilepticus
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*[[Antibiotics (Main)]]
 
*[[Antibiotics (Main)]]
  
==Source==
+
==References==
* Epocrates
+
*Epocrates
 
<references/>
 
<references/>
[[Category:Drugs]]
+
[[Category:Pharmacology]]
 +
 
 +
*Lexicomp
 +
Accessed September 4, 2019

Latest revision as of 01:28, 21 February 2021

General

  • Type: Fourth generation cephalosporin
  • Dosage Forms: infusion solution, powder for injection
  • Dosage Strengths: infusion solution: 1g/50mL, 2g/100mL; powder for injection: 1g, 2g
  • Routes of Administration: IV, IM
  • Common Trade Names: Maxipime

Adult Dosing

Bacterial Infections

  • 1-2 g IV q12H (Max: 6 g/24h; dose, duration varies with infection type, severity)

Febrile Neutropenia

  • 2g IV q8H

UTI, mild-moderate

  • 0.5-1g IV/IM q12H x7-10 days (IM only for UTI due to E. coli)

UTI, severe

  • 2g IV q12H x10 days

Renal dosing

  • Febrile Neutropenia: CrCl 30-60: 2 g q12H; CrCl 11-29: 2 g q24H; CrCL <11: 2gx1, then 1g q24H; HD: 1g q24H, give after dialysis; PD: 2g q48H
  • All other infections: CrCl 30-60: give q24h; CrCl 11-29: give usual dose x1, then 0.5-1 g q24h; CrCl <11: give usual dose x1, then 250-500mg q24h; HD: 1 g x1, then 500mg q24h, give after dialysis; PD: give usual dose q48h

Hepatic Dosing

  • no adjustment

Pediatric Dosing

  • Mild to moderate infection: 50 mg/kg/dose every 12 hours; maximum dose: 2,000 mg/dose
  • Severe infection: 50 mg/kg/dose every 8 to 12 hours; maximum dose: 2,000 mg/dose

Bacterial Infections

  • >2 mo: Dose: 50mg/kg IV/IM q12h; Max: 2 g/dose; Info: duration varies with infection type, severity; IM only for mild-mod. UTI due to E. coli

Febrile Neutropenia

  • >2 mo: Dose: 50mg/kg IV q8h; Max: 2 g/dose

Respiratory Infections, cystic fibrosis patients

  • >2 mo: Dose: 50mg/kg IV q8h x2wk; Max: 2 g/dose

Renal Dosing

  • Febrile Neutropenia, cystic fibrosis: CrCl 30-60: 50mg/kg q12h; CrCl 11-29: 50mg/kg q24h; CrCl <11: 50mg/kg x1, then 25mg/kg q24h; HD: 25mg/kg q24h, give after dialysis; PD: 50mg/kg q48h
  • all other infections: CrCl 30-60: 50mg/kg q24h; CrCl 11-29: 50mg/kg x1, then 25-50mg/kg q24h; CrCl <11: 50mg/kg x1, then 12.5-25mg/kg q24h; HD: 50mg/kg x1, then 25mg/kg q24h, give after dialysis; PD: 50mg/kg q48h

Hepatic Dosing

  • No Adjustment

Special Populations

  • Pregnancy: B
  • Lactation: Probably safe
  • Renal Dosing
    • Adult: CrCl 30-60: give q24h; CrCl 11-29: give usual dose x1, then 0.5-1 g q24h; CrCl <11: give usual dose x1, then 250-500mg q24h; HD: 1 g x1, then 500mg q24h, give after dialysis; PD: give usual dose q48h
    • Pediatric: CrCl 30-60: 50mg/kg q24h; CrCl 11-29: 50mg/kg x1, then 25-50mg/kg q24h; CrCl <11: 50mg/kg x1, then 12.5-25mg/kg q24h; HD: 50mg/kg x1, then 25mg/kg q24h, give after dialysis; PD: 50mg/kg q48h
  • Hepatic Dosing
    • Adult: No adjustment
    • Pediatric: No adjustement

Contraindications

  • Allergy to class/drug (See also Cephalosporin Cross-reactivity
  • Caution if hypersensitive to PCN
  • Caution if recent antibiotic-associated colitis history
  • Caution if GI disorder history
  • caution if H. influenzae infection (pediatric patients)

Adverse Reactions

Serious

  • Anaphylaxis
  • Encephalopathy (patients with renal insufficiency more prone)
  • Seizures
  • Non-convulsive status epilepticus
  • Leukopenia
  • Thrombocytopenia
  • Agranulocytosis
  • Anemia, hemolytic
  • Aplastic anemia
  • Hemorrhage
  • Stevens-Johnson syndrome
  • Toxic epidermal necrolysis
  • Erythema multiforme
  • Clostridium difficile associated diarrhea

Common

Pharmacology

  • Half-life: 2 hours, 13.5 hours (HD), 19 hours (CAPD)
  • Metabolism: minimal, site unknown; CYP450: unknown
  • Excretion: urine primarily (85% unchanged)
  • Mechanism of Action: bactericidal; inhibits cell wall mucopeptide synthesis

Antibiotic Sensitivities[1]

Group Organism Sensitivity
Gram Positive Strep. Group A, B, C, G S
Strep. Pneumoniae S
Viridans strep S
Strep. anginosus gp X1
Enterococcus faecalis R
Enterococcus faecium X1
MSSA S
MRSA R
CA-MRSA R
Staph. Epidermidis I
C. jeikeium X1
L. monocytogenes R
Gram Negatives N. gonorrhoeae I
N. meningitidis S
Moraxella catarrhalis S
H. influenzae S
E. coli S
Klebsiella sp S
E. coli/Klebsiella ESBL+ R
E coli/Klebsiella KPC+ R
Enterobacter sp, AmpC neg S
Enterobacter sp, AmpC pos R
Serratia sp S
Serratia marcescens X1
Salmonella sp S
Shigella sp S
Proteus mirabilis S
Proteus vulgaris S
Providencia sp. S
Morganella sp. S
Citrobacter freundii S
Citrobacter diversus S
Citrobacter sp. S
Aeromonas sp S
Acinetobacter sp. I
Pseudomonas aeruginosa S
Burkholderia cepacia I
Stenotrophomonas maltophilia R
Yersinia enterocolitica S
Francisella tularensis X1
Brucella sp. X1
Legionella sp. R
Pasteurella multocida S
Haemophilus ducreyi X1
Vibrio vulnificus X1
Misc Chlamydophila sp X1
Mycoplasm pneumoniae X1
Rickettsia sp X1
Mycobacterium avium X1
Anaerobes Actinomyces X1
Bacteroides fragilis R
Prevotella melaninogenica R
Clostridium difficile R
Clostridium (not difficile) X1
Fusobacterium necrophorum X1
Peptostreptococcus sp. S

Key

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also

References

  • Epocrates
  1. Sanford Guide to Antimicrobial Therapy 2014
  • Lexicomp

Accessed September 4, 2019