Cefepime: Difference between revisions

Line 89: Line 89:
*Excretion: urine primarily (85% unchanged)
*Excretion: urine primarily (85% unchanged)
*Mechanism of Action: bactericidal; inhibits cell wall mucopeptide synthesis
*Mechanism of Action: bactericidal; inhibits cell wall mucopeptide synthesis
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
{| class="wikitable"
| align="center" style="background:#f0f0f0;"|'''Group'''
| align="center" style="background:#f0f0f0;"|'''Organism'''
| align="center" style="background:#f0f0f0;"|'''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===
{{Template:Antibacterial Spectra Key}}


==See Also==
==See Also==

Revision as of 03:55, 24 June 2014

General

  • Type: Fourth generation cephalosporin
  • Dosage Forms: 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 250-500 mg q24h; HD: 1 g x1, then 500 mg q24h, give after dialysis; PD: give usual dose q48h

Hepatic Doseing

  • no adjustment

Pediatric Dosing

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

Febrile Neutropenia

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

Respiratory Infections, cystic fibrosis pts

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

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
  • 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

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 250-500 mg q24h; HD: 1 g x1, then 500 mg 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
  • 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 abx-associated colitis history
  • Caution if GI disorder history
  • caution if H. influenzae infection (peds patients)

Adverse Reactions

Serious

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

Source

  • Epocrates
  1. Sanford Guide to Antimicrobial Therapy 2014