cefepime (Rx)

Brand and Other Names:Maxipime
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

infusion solution

  • 1g/50mL
  • 2g/100mL

powder for injection

  • 1g
  • 2g

Pneumonia

Treatment of moderate-to-severe pneumonia

1-2 g IV q8-12hr for 7-10 days (if not caused by Pseudomonas) or for up to 21 days (if caused by Pseudomonas)

Febrile Neutropenia

Empiric therapy in febrile neutropenic patients

2 g IV q8hr for 7 days or until neutropenia resolves

Urinary Tract Infections

Treatment of uncomplicated and complicated urinary tract infections (UTIs), including pyelonephritis

0.5-1 g IV or IM q12hr for 7-10 days

Severe UTIs due to Escherichia coli or Klebsiella pneumoniae: 2 g IV q12hr for 10 days

Skin/Skin Structure Infections

Treatment of uncomplicated skin and skin structure infections

2 g IV q12hr for 10 days

Intra-abdominal Infections

Treatment of complicated intra-abdominal infections; use in combination with metronidazole

2 g IV q12hr for 7-10 days

Dosing Modifications

Adjust recommended maintenance dosages according to CrCl

Recommended maintenance dosage 500 mg q12hr

  • CrCl >60 mL/min: 500 mg q12hr
  • CrCl 30-60 mL/min: 500 mg q24hr
  • CrCl 11-29 mL/min: 500 q24hr
  • CrCl <11 mL/min: 250 q24hr
  • Continuous ambulatory peritoneal dialysis (CAPD): 500 mg q48hr
  • Hemodialysis: 1 g on day 1, then 500-1000 mg q24hr thereafter (on hemodialysis days, administer after hemodialysis)

Recommended maintenance dosage 1 g q12hr

  • CrCl >60 mL/min: 1 g q12hr
  • CrCl 30-60 mL/min: 1 g q24hr
  • CrCl 11-29 mL/min: 500 mg q24hr
  • CrCl <11 mL/min: 250 mg q24hr
  • CAPD: 1 g q48hr
  • Hemodialysis: 1 g on day 1, then 500 mg q24hr thereafter (on hemodialysis days, administer after hemodialysis)

Recommended maintenance dosage 2 g q12hr

  • CrCl >60 mL/min: 2 g q12hr
  • CrCl 30-60 mL/min: 2 g q24hr
  • CrCl 11-29 mL/min: 1 g q24hr
  • CrCl <11 mL/min: 500 mg q24hr
  • CAPD: 2 g q48hr
  • Hemodialysis: 1 g on day 1, then 500 mg q24hr thereafter (on hemodialysis days, administer after hemodialysis)

Recommended maintenance dosage 2 g q8hr

  • CrCl >60 mL/min: 2 g q8hr
  • CrCl 30-60 mL/min: 2 g q12hr
  • CrCl 11-29 mL/min: 2 g q24hr
  • CrCl <11 mL/min: 1 g q24hr
  • CAPD: 2 g q48hr
  • Hemodialysis: 1 g q24hr (on hemodialysis days, administer after hemodialysis)

Dosing Considerations

Susceptible organisms

  • Bacteroides spp, Enterobacter spp, Escherichia coli, Haemophilus influenzae, Klebsiella spp, Proteus mirabilis, Pseudomonas spp, Staphylococcus aureus, Streptococcus pyogenes

Dosage Forms & Strengths

infusion solution

  • 1g/50mL
  • 2g/100mL

powder for injection

  • 1g
  • 2g

Febrile Neutropenia

Empiric therapy in febrile neutropenic patients

>2 months, <40 kg: 50 mg/kg IV q8hr for 7 days or until neutropenia resolves; not to exceed 2 g q8hr  

Pneumonia

Treatment of moderate-to-severe pneumonia

50 mg/kg IV q12hr for 10 days; not to exceed 2 g q12hr  

Skin/Skin Structure Infections

Treatment of uncomplicated skin and skin structure infections

50 mg/kg IV q12hr for 10 days; not to exceed 2 g q12hr  

Urinary Tract Infections

Treatment of uncomplicated and complicated UTIs, including pyelonephritis

50 mg/kg IV/IM q12hr for 7-10 days; not to exceed 2 g q12hr  

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Interactions

Interaction Checker

and cefepime

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    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

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            Contraindicated (0)

              Serious - Use Alternative (3)

              • BCG vaccine live

                cefepime decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

              • cholera vaccine

                cefepime, cholera vaccine. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid coadministration of cholera vaccine with systemic antibiotics since these agents may be active against the vaccine strain. Do not administer cholera vaccine to patients who have received oral or parenteral antibiotics within 14 days prior to vaccination.

              • typhoid vaccine live

                cefepime decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

              Monitor Closely (8)

              • amifampridine

                cefepime increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.

              • bazedoxifene/conjugated estrogens

                cefepime will decrease the level or effect of bazedoxifene/conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • dienogest/estradiol valerate

                cefepime will decrease the level or effect of dienogest/estradiol valerate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. An alternate or additional form of birth control may be advisable during concomitant use.

              • estradiol

                cefepime will decrease the level or effect of estradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • ethinylestradiol

                cefepime will decrease the level or effect of ethinylestradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • levonorgestrel oral/ethinylestradiol/ferrous bisglycinate

                cefepime will decrease the level or effect of levonorgestrel oral/ethinylestradiol/ferrous bisglycinate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. Antibiotics may decrease hormonal contraceptive efficacy.

              • probenecid

                probenecid will increase the level or effect of cefepime by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.

              • sodium picosulfate/magnesium oxide/anhydrous citric acid

                cefepime decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.

              Minor (10)

              • aminohippurate sodium

                cefepime will increase the level or effect of aminohippurate sodium by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • aspirin

                cefepime will increase the level or effect of aspirin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • aspirin rectal

                cefepime will increase the level or effect of aspirin rectal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • aspirin/citric acid/sodium bicarbonate

                cefepime will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • choline magnesium trisalicylate

                cefepime will increase the level or effect of choline magnesium trisalicylate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • furosemide

                cefepime increases toxicity of furosemide by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of nephrotoxicity.

              • rose hips

                rose hips will increase the level or effect of cefepime by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • sulfasalazine

                cefepime will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • tolmetin

                cefepime will increase the level or effect of tolmetin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • willow bark

                cefepime will increase the level or effect of willow bark by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

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              Adverse Effects

              >10%

              Positive Coombs test result without hemolysis (16%)

              1-10%

              Rash (1-4%)

              Elevated alanine aminotransferase (3%)

              Hypophosphatemia (3%)

              Diarrhea (<3%)

              Eosinophilia (2%)

              Erythema at injection site (2%)

              Normal partial thromboplastin time (PTT) (2%)

              Nausea or vomiting (<2%)

              Fever (1%)

              Headache (1%)

              Pain (1%)

              Pruritus (1%)

              <1%

              Agranulocytosis

              Anaphylactic shock

              Anaphylaxis

              Coma

              Encephalopathy

              Hallucinations

              Leukopenia

              Myoclonus

              Neuromuscular excitability

              Neutropenia

              Seizures

              Thrombocytopenia

              Postmarketing Reports

              Neurotoxicity: Encephalopathy, aphasia, nonconvulsive status epilepticus

              Other: Anaphylaxis (including anaphylactic shock), transient leukopenia

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              Warnings

              Contraindications

              Documented hypersensitivity to cefepime, penicillins, or other beta-lactam antibiotics

              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, penicillins, or other drugs

              Use with caution in patients with GI disease, particularly colitis

              If CrCl <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
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              Pregnancy & Lactation

              Pregnancy

              There are no cases of drug exposure during pregnancy reported from postmarketing 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

              Animal data

              • Cefepime was not associated with adverse developmental outcomes in rats, mice, or rabbits when administered parenterally during period of organogenesis; the doses used in these studies were 1.6 times (rats), approximately equal to (mice) and 0.3 times (rabbits) the maximum recommended clinical dose

              Lactation

              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

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Fourth-generation cephalosporin; has gram-negative coverage comparable to ceftazidime but better gram-positive coverage (comparable to ceftriaxone); is zwitterion and rapidly penetrates gram-negative cells; is best beta-lactam for IM administration; has poor capacity to cross blood-brain barrier and thus is not used for treatment of meningitis

              Absorption

              IM absorption rapid and complete

              Peak plasma time: 0.5-1.5 hr (IV); 1-2 hr (IM)

              Distribution

              Penetrates into inflammatory fluid at concentrations ~80% of serum levels and into bronchial mucosa at concentrations ~60% of plasma levels; crosses blood-brain barrier

              Protein bound: 16-19%

              Vd: 16-20 L (adults)

              Metabolism

              Minimally metabolized in liver

              Elimination

              Half-life: 2 hr

              Excretion: Urine (85% as unchanged drug)

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              Administration

              IV Incompatibilities

              Additive: Aminophylline, ampicillin(?), gentamicin, netilmicin, tobramycin

              Y-site: Acyclovir, amphotericin B, amphotericin B cholesteryl sulfate, chlordiazepoxide, chlorpromazine, cimetidine, ciprofloxacin, cisplatin, dacarbazine, daunorubicin, diazepam, diphenhydramine, dobutamine, dopamine, doxorubicin, droperidol, enalaprilat, etoposide, etoposide phosphate, famotidine, filgrastim, floxuridine, ganciclovir, haloperidol, hydroxyzine, idarubicin, ifosfamide, magnesium sulfate, mannitol, mechlorethamine, meperidine, metoclopramide, mitomycin, mitoxantrone, morphine, nalbuphine, ofloxacin, ondansetron, plicamycin, prochlorperazine, promethazine, streptozocin, vancomycin, vinblastine, vincristine

              IV Compatibilities

              Solution compatible with most common solvents

              Additive: Amikacin, clindamycin, heparin, metronidazole(?), potassium chloride, theophylline, vancomycin

              Y-site (partial list): Ampicillin-sulbactam, calcium gluconate, carboplatin, dexamethasone sodium phosphate, fluconazole, fluorouracil, metronidazole, milrinone, propofol, sodium bicarbonate, trimethoprim-sulfamethoxazole (TMP-SMX)

              IV Preparation

              Reconstitute with 50-100 mL of NS, D5W, D10W, LR, D5/LR, or other compatible fluid

              Thaw infusion solution at room temperature or in refrigerator, not in water bath or microwave oven

              IV Administration

              Infuse intermittently over 30 minutes

              Do not administer other drugs through Y-site

              IM Preparation

              Add 2.4 mL of appropriate diluent (SWI, NS, D5W etc) to 1 g vial to yield solution containing approximately 280 mg/mL

              IM Administration

              Inject deeply

              Give IM only in mild-to-moderate UTI due to E coli

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
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              Copyright © 2010 First DataBank, Inc.

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              cefepime intravenous

              CEFEPIME - INJECTION

              (SEF-e-peem)

              COMMON BRAND NAME(S): Maxipime

              USES: Cefepime is used to treat a wide variety of bacterial infections. This medication belongs to a class of drugs known as cephalosporin antibiotics. It works by stopping the growth of bacteria.

              HOW TO USE: This medication is given by injection into a muscle or vein as directed by your doctor. The dosage is based on your medical condition and response to treatment.If you are using this medication at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.If you are using the frozen pre-mixed solution, thaw the bag at room temperature or in the refrigerator. If the bag is thawed in the refrigerator, let it sit at room temperature at least 1 hour before using. Do not thaw by putting in a water bath or microwaving. After thawing, shake well and squeeze the bag to check for leaks. Discard solution if the bag leaks. Do not re-freeze the solution after thawing.For the best effect, use this antibiotic at evenly spaced times. To help you remember, use this medication at the same time(s) every day.Continue to use this medication for the full time prescribed, even if symptoms disappear after a few days. Stopping the medication too early may result in a return of the infection.Tell your doctor if your condition lasts or gets worse.

              SIDE EFFECTS: Swelling, redness, or pain at the injection site may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: easy bruising/bleeding, unusual tiredness, uncontrollable movements, mental/mood changes (such as confusion, hallucinations, decreased alertness), seizures, trouble speaking, signs of kidney problems (such as change in the amount of urine), signs of liver problems (such as nausea/vomiting that doesn't stop, loss of appetite, stomach/abdominal pain, yellowing eyes/skin, dark urine).This medication may rarely cause a severe intestinal condition due to a bacteria called C. difficile. This condition may occur during treatment or weeks to months after treatment has stopped. Tell your doctor right away if you develop: diarrhea that doesn't stop, abdominal or stomach pain/cramping, blood/mucus in your stool.If you have these symptoms, do not use anti-diarrhea or opioid products because they may make symptoms worse.Use of this medication for prolonged or repeated periods may result in oral thrush or a new yeast infection. Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge, or other new symptoms.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before using cefepime, tell your doctor or pharmacist if you are allergic to it; or to other antibiotics (such as penicillins, other cephalosporins); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, stomach/intestinal diseases (such as colitis).Cefepime may cause live bacterial vaccines (such as typhoid vaccine) to not work well. Tell your health care professional that you are using cefepime before having any immunizations/vaccinations.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Tell your doctor if you are pregnant before using this medication.This medication passes into breast milk in small amounts and is unlikely to harm a nursing infant. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.This medication may interfere with certain lab tests (including certain urine glucose tests), possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: seizures.

              NOTES: Do not share this medication with others.Lab and/or medical tests (such as complete blood count, kidney function tests) should be done while you are using this medication. Keep all medical and lab appointments.

              MISSED DOSE: It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule. Do not double the dose to catch up.

              STORAGE: Consult the product instructions and your pharmacist for storage details. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              Information last revised October 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

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              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.