Cefepime

Cefepime is a prescription medication used to treat the symptoms of Pneumonia, Febrile Neutropenia, Urinary Tract Infections, Skin and Skin Structure Infections, and Intra-abdominal Infections. 

Cefepime is available under the following different brand names: Maxipime

Adult and Pediatric dosage

Infusion solutions

• 1g/50mL
• 2g/100mL

Powder for Injection

Adult dosage

• 1g
• 2g

Pneumonia

Adult dosage

Treatment of moderate-to-severe pneumonia

• 1-2g IV every 8-12 hours for 7-10 days (if not caused by Pseudomonas) or for up to 21 days (if caused by Pseudomonas)

Pediatric dosage

• 50 mg/kg IV every 12 hours for 10 days; not to exceed 2 g every 12 hours

Febrile Neutropenia

Adult dosage

• 2g IV every 8 hours for 7 days or until neutropenia resolves

Pediatric dosage

• Older than 2 months, weighing less than 40 kg: 50 mg/kg IV every 8 hours for 7 days or until neutropenia resolves; not to exceed 2 g every 8 hours

Urinary Tract Infections

Adult dosage

• 0.5-1g IV or IM every 12 hours for 7-10 days
• Severe UTIs due to Escherichia coli or Klebsiella pneumoniae: 2g IV every 12 hours for 10 days

Pediatric dosage

• 50 mg/kg IV/IM every 12 hours for 7-10 days; not to exceed 2 g every 12 hours

Skin/Skin Structure Infections

Adult dosage

• 2g IV every 12 hours for 10 days

Pediatric dosage

• 50 mg/kg IV every 12 hours for 10 days; not to exceed 2 gram every 12 hours

Intra-abdominal Infections

Adult dosage

• 2g IV ever 12 hours for 7-10 days

Dosage Considerations – Should be Given as Follows: 

• See "Dosages."

Common side effects of Cefepime include:

• nausea, 
• vomiting, 
• diarrhea, 
• fever, 
• headache, 
• itching, 
• rash, and 
• abnormal blood tests

Serious side effects of Cefepime include:

• hives, 
• difficulty breathing, 
• swelling of your face, lips, tongue, or throat, 
• fever, 
• sore throat, 
• burning eyes, 
• skin pain, 
• red or purple skin rash with blistering and peeling, 
• severe stomach pain, 
• diarrhea that is watery or bloody (even if it occurs months after your last dose), 
• confusion, 
• hallucinations, 
• trouble speaking, reading, or understanding the words of other people, 
• seizure, 
• pale skin, 
• easy bruising, 
• unusual bleeding, 
• dark colored urine, and
• yellowing of the skin or eyes (jaundice)

Rare side effects of Cefepime include:

• none 

This is not a complete list of side effects and other serious side effects or health problems may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them.  Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first

• Cefepime has severe interactions with no drugs. 
• Cefepime has serious interactions with the following drugs:
  • BCG vaccine live
  • cholera vaccine
  • typhoid vaccine live
• Cefepime has moderate interactions with the following drugs:
  • amifampridine
  • bazedoxifene/conjugated estrogens
  • dienogest/estradiol valerate
  • estradiol
  • ethinylestradiol
  • levonorgestrel oral/ethinylestradiol/ferrous bisglycinate
  • probenecid
  • sodium picosulfate/magnesium oxide/anhydrous citric acid
• Cefepime has minor interactions with the following drugs: 
  • aminohippurate sodium
  • aspirin
  • aspirin rectal
  • aspirin/citric acid/sodium bicarbonate
  • choline magnesium trisalicylate
  • furosemide
  • rose hips
  • sulfasalazine
  • tolmetin
  • willow bark

This information does not contain all possible interactions or adverse effects.  Visit the RxList Drug Interaction Checker for any drugs interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use.  Keep a list of all your medications with you, and share this information with your doctor and pharmacist.  Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns.

Contraindications

• Documented hypersensitivity to cefepime, penicillin, or other beta-lactam antibiotics

Effects of drug abuse

• None

Short-Term Effects

• See “What are Side Effects Associated with Using Cefepime?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Cefepime?”

Cautions

• IM recommended only for mild-to-moderate complicated or uncomplicated UTI due to E coli
• Prescribing drug in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to patient and increases risk of development of drug-resistant bacteria
• Prolonged use may cause superinfection
• May increase international normalized ratio (INR) with prolonged treatment, especially in nutritionally deficient patients
• Caution warranted with history of previous immediate hypersensitivity reactions to cefepime, cephalosporins, penicillin, or other drugs
• Use with caution in patients with GI disease, particularly colitis
• If CrCl is less than 60 mL/min, adjust dosage to compensate for slower renal elimination rate
• Neurotoxicity has been reported, including life-threatening or fatal occurrences such as aphasia, encephalopathy, myoclonus, seizures, and nonconvulsive status epilepticus
• Clostridioides difficile
  • Clostridioides difficile-associated diarrhea (CDAD) may occur and should be considered in all patients who present with persistent diarrhea after use
  • Careful medical history is necessary since CDAD has been reported to occur over two months after administration of antibacterial agents
  • C. difficile produces toxins A and B, which contribute to development of CDAD
  • Hypertoxin-producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy
  • Careful medical history is necessary since CDAD has been reported to occur over two months after administration of antibacterial agents
  • If CDAD is suspected or confirmed, ongoing antibacterial drug use not directed against C. difficile may need to be discontinued
  • Appropriate fluid and electrolyte management, protein supplementation, antibacterial drug treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated
• Nonconvulsive status epilepticus
  • Risk of nonconvulsive status epilepticus may be increased if inadequate dosing adjustment is made with renal impairment
  • Most cases occurred in patients with renal impairment who did not receive appropriate dosage adjustment; however, some occurred in patients receiving dosage adjustment appropriate for their degree of renal impairment
  • Signs and symptoms of nonconvulsive status epilepticus may include altered mental status, confusion, and decreased responsiveness

Pregnancy and Lactation

• There are no cases of drug exposure during pregnancy reported from post-marketing experience or from clinical trials; available data from published observational studies and case reports over several decades with cephalosporin use in pregnant women have not established drug-associated risks of major birth defects, miscarriage or adverse maternal or fetal outcomes
• Drug is present in human milk at low concentration (0.5 mcg/mL); a nursing infant consuming approximately 1000 mL of human milk per day would receive approximately 0.5 mg of cefepime per day
• There is no information regarding effects on milk production or on breastfed infant
• Developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for cefepime and any potential adverse effects on breastfed child from drug or from underlying maternal condition