Cefepime

Revision as of 00:56, 17 May 2014 by MBMD (talk | contribs) (Contraindications)

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

See Also

Source

  • Epocrates