Cefepime: Difference between revisions
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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 | ||
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==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=== | ||
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*Caution if recent antibiotic-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 ( | *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)]] | ||
== | ==References== | ||
*Epocrates | *Epocrates | ||
<references/> | <references/> | ||
[[Category:Pharmacology]] | [[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
- Rash
- Injection site reaction
- Diarrhea
- Hypophosphatemia
- ALT, AST elevated
- Nausea
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]
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
- ↑ Sanford Guide to Antimicrobial Therapy 2014
- Lexicomp
Accessed September 4, 2019