Cefepime: Difference between revisions
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*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
- Anaphylaxis
- Encephalopathy
- 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
Source
- Epocrates
- ↑ Sanford Guide to Antimicrobial Therapy 2014