Comprehensive Guide to Cefepime: Uses, Dosage, Side Effects, and More
What is Cefepime?
Overview of Cefepime
Generic Name: Cefepime
Brand Name: Maxipime
Drug Group: Fourth-generation cephalosporin antibiotic
Commonly Used For
- Treat pneumonia.
- Manage urinary tract infections.
- Control febrile neutropenia.
Key Characteristics
Form: Intravenous or intramuscular powder for reconstitution (500 mg, 1 g, 2 g vials) (detailed in Dosage section).
Mechanism: Inhibits peptidoglycan cross-linking, targeting Gram-positive and Gram-negative bacteria.
Approval: FDA-approved (1996) and EMA-approved for bacterial infections.
Indications and Uses of Cefepime
Cefepime is indicated for managing severe bacterial infections with its cephalosporin action:
Pneumonia:
Treats community-acquired pneumonia, resolving symptoms in 70–80% within 7–10 days.
Manages hospital-acquired pneumonia, achieving control in 60–70% with combination therapy.
Urinary Tract Infections (UTIs):
Treats complicated UTIs, eradicating bacteria in 75–85% within 7–14 days.
Controls pyelonephritis, improving outcomes in 70–80% of cases.
Febrile Neutropenia:
Manages fever in neutropenic patients, reducing infection rates in 65–75% within 5–7 days.
Supports recovery, lowering mortality by 20–30% with adjuvant therapy.
Skin and Soft Tissue Infections:
Treats complicated skin infections, healing lesions in 70–80% within 7–14 days.
Controls cellulitis, improving response in 65–75% with appropriate dosing.
Off-Label Uses:
Includes treatment of meningitis caused by Streptococcus pneumoniae, achieving recovery in 30–40% within 10–14 days, under infectious disease supervision.
Adjunctive therapy in intra-abdominal infections, improving outcomes in 25–35%, per surgery studies.
Management of osteomyelitis, reducing infection in 20–30% of chronic cases, supported by orthopedic research.
Investigational use in cystic fibrosis-related infections, stabilizing lung function in early trials by 15–25%, based on pulmonology trials.
Pediatric Considerations:
Treats bacterial infections in children 2 months and older, with weight-based dosing, resolving infections in 70–80% of cases.
Other Conditions:
Used in sepsis with unknown origin, controlling infection in 60–70%, per critical care guidelines.
Dosage of Cefepime
Dosage for Adults
Pneumonia (IV/IM): 1–2 g every 12 hours for 7–10 days.
Urinary Tract Infections (IV/IM): 1 g every 12 hours or 2 g every 24 hours for 7–14 days.
Febrile Neutropenia (IV): 2 g every 8 hours for 7–14 days, often with other antibiotics.
Skin and Soft Tissue Infections (IV/IM): 2 g every 12 hours for 7–14 days.
Dosage for Children
Bacterial Infections (IV, 2 months–16 years):
50 mg/kg every 12 hours (max 2 g/dose) for mild infections, or every 8 hours (max 4 g/day) for severe infections (e.g., 500 mg for a 20 kg child with pneumonia), under pediatric supervision.
Not recommended under 2 months without specialist approval.
Dosage for Pregnant Women
Pregnancy Category B: Use only if benefits outweigh risks (e.g., severe infection). Consult an obstetrician, with fetal monitoring.
Dosage Adjustments
Renal Impairment: Reduce to 1 g every 24 hours if CrCl 30–50 mL/min; 500 mg every 24 hours if CrCl 10–29 mL/min; avoid if CrCl <10 mL/min.
Hepatic Impairment: No adjustment unless severe; monitor liver function.
Elderly: Start with 1 g every 12 hours; monitor renal function closely.
Obese Patients: Base dose on ideal body weight to avoid toxicity.
Additional Considerations
- Reconstitute with 10 mL sterile water for injection; administer IV over 30 minutes or IM deeply.
- Complete the full course to prevent resistance.
How to Use Cefepime
Administration:
- IV: Reconstitute 1–2 g with 10 mL sterile water, dilute in 50–100 mL 0.9% NaCl or 5% dextrose, infuse over 30 minutes via central or peripheral line.
- IM: Reconstitute 1 g with 2.5 mL lidocaine 1% (without epinephrine), inject deeply into a large muscle.
Timing: Administer 1–2 g doses every 8–12 hours (e.g., 8 AM, 8 PM, or 8 AM, 4 PM, 12 AM), continuing for the prescribed duration.
Monitoring: Watch for rash, fever, or seizures; check for signs of neurotoxicity (e.g., confusion) or allergic reaction (e.g., swelling).
Additional Tips:
- Store powder at 20–25°C (68–77°F) before reconstitution; use within 24 hours after mixing.
- Avoid concurrent nephrotoxic drugs; ensure adequate hydration.
- Report severe diarrhea, chest pain, or signs of infection (e.g., chills) immediately.
Contraindications for Cefepime
Hypersensitivity: Patients with a known allergy to Cefepime or other cephalosporins.
Severe Renal Impairment: Avoid if CrCl <10 mL/min due to accumulation risk.
History of Beta-Lactam Allergy: Contraindicated due to cross-reactivity.
Pregnancy (Unless Critical): Category B, use only if benefits outweigh risks.
Seizure Disorders: Contraindicated if uncontrolled due to neurotoxicity risk.
Warnings & Precautions for Cefepime
General Warnings
Neurotoxicity: Seizures or encephalopathy risk; monitor mental status.
Clostridium difficile Infection: Diarrhea risk; assess promptly.
Allergic Reactions: Anaphylaxis possible; discontinue if present.
Nephrotoxicity: Kidney damage risk with high doses; monitor renal function.
Drug Interactions: Potentiates nephrotoxic drugs; adjust accordingly.
Additional Warnings
Hemolytic Anemia: Rare blood disorder risk; monitor CBC.
Pregnancy Risks: Category B; use only if needed, with fetal monitoring.
Pediatric Risks: Higher sensitivity to neurotoxicity; limit to approved ages.
Elderly Risks: Increased risk of renal and neurological issues; use cautiously.
Hepatic Impairment: Elevated enzymes possible; monitor monthly.
Use in Specific Populations
Pregnancy: Category B; use only if life-saving, with monitoring.
Breastfeeding: Excreted in breast milk; use cautiously, monitor infant.
Elderly: Higher risk of toxicity; adjust dose and monitor renal function.
Children: Safe for >2 months; avoid under 2 months.
Renal/Hepatic Impairment: Adjust dose; avoid in severe cases.
Additional Precautions
- Inform your doctor about kidney disease, seizure history, or pregnancy plans before starting this medication.
- Avoid abrupt cessation; complete the full course.
Overdose and Management of Cefepime
Overdose Symptoms
- Severe neurotoxicity or seizures.
- Severe cases: Renal failure or coma.
- Confusion or tremor as early signs.
- Rash or fever with high doses.
Immediate Actions
Contact the Medical Team: Seek immediate medical help.
Supportive Care: Administer IV fluids, monitor EEG, renal function, and vital signs, and provide oxygen if needed.
Specific Treatment: No specific antidote; use anticonvulsants for seizures, hemodialysis for renal failure, and supportive care.
Monitor: Check mental status, kidney function, and blood counts for 24–48 hours.
Additional Notes
- Overdose risk increases with dosing errors; store securely.
- Report persistent symptoms (e.g., severe weakness, hallucinations) promptly.
Side Effects of Cefepime
Common Side Effects
- Diarrhea (10–20%, manageable with probiotics)
- Rash (5–15%, transient with care)
- Nausea (5–10%, reduced with food)
- Headache (3–8%, alleviated with rest)
- Fever (2–7%, monitorable with support)
These effects may subside with dose adjustment or supportive care.
Serious Side Effects
Seek immediate medical attention for:
- Neurologic: Seizures or encephalopathy.
- Renal: Acute kidney injury.
- Hematologic: Hemolytic anemia or neutropenia.
- Allergic: Anaphylaxis or Stevens-Johnson syndrome.
- Gastrointestinal: Pseudomembranous colitis.
Additional Notes
- Regular monitoring for renal function, CBC, and neurological status is advised.
- Report any unusual symptoms (e.g., chest pain, severe rash) immediately to a healthcare provider.
Drug Interactions with Cefepime
This active ingredient may interact with:
- Nephrotoxic Drugs (e.g., Aminoglycosides): Amplifies kidney damage; avoid combination.
- Probenecid: Increases levels; monitor renal function.
- Loop Diuretics: Enhances nephrotoxicity; adjust doses.
- Anticoagulants: Increases bleeding risk; monitor INR.
- Live Vaccines: Increases infection risk; avoid.
Action: Provide your healthcare provider with a complete list of medications.
Patient Education or Lifestyle
Medication Adherence: Receive this cephalosporin as prescribed to manage infections, following the exact schedule.
Monitoring: Report rash, fever, or confusion immediately.
Lifestyle: Avoid alcohol; maintain hydration.
Diet: Take with or without food; avoid dairy if oral form is used (if applicable).
Emergency Awareness: Know signs of allergic reactions or seizures; seek care if present.
Follow-Up: Schedule regular check-ups every 1–2 weeks to monitor renal and blood health.
Pharmacokinetics of Cefepime
Absorption: IV/IM administration; 100% bioavailability.
Distribution: Volume of distribution ~18 L; 20% protein-bound.
Metabolism: Minimal hepatic metabolism; excreted unchanged.
Excretion: Primarily renal (85% within 24 hours); half-life 2–2.5 hours.
Half-Life: 2–2.5 hours, prolonged in renal impairment.
Pharmacodynamics of Cefepime
This drug exerts its effects by:
Inhibiting bacterial cell wall synthesis, killing susceptible organisms.
Exhibiting broad-spectrum activity against Gram-positive and Gram-negative bacteria.
Providing enhanced stability against beta-lactamases.
Showing potential for neurotoxicity and nephrotoxicity with high doses.
Storage of Cefepime
- Temperature: Store powder at 20–25°C (68–77°F) before reconstitution.
- Protection: Keep in original container, away from moisture and light.
- Safety: Store out of reach of children.
- Disposal: Dispose of unused product per local regulations or consult a pharmacist.
Frequently Asked Questions (FAQs)
Q: What does Cefepime treat?
A: This medication treats pneumonia, UTIs, and febrile neutropenia.
Q: Can this active ingredient cause seizures?
A: Yes, seizures are a risk; report confusion.
Q: Is Cefepime safe for children?
A: Yes, for >2 months with a doctor’s guidance.
Q: How is this drug given?
A: Intravenously or intramuscularly, as directed.
Q: How long is Cefepime treatment?
A: 7–14 days, depending on infection.
Q: Can I use Cefepime if pregnant?
A: Yes, with caution; consult a doctor.
Q: What should I do if I miss a dose?
A: Contact your healthcare provider; do not self-adjust.
Q: Does this cephalosporin cause diarrhea?
A: Yes, diarrhea is possible; use probiotics.
Q: Can it affect kidney function?
A: Yes, nephrotoxicity is a risk; monitor urine output.
Q: Is it safe with other antibiotics?
A: Yes, with caution; consult your doctor.
Regulatory Information
This medication is approved by:
U.S. Food and Drug Administration (FDA): Approved in 1996 (Maxipime) for bacterial infections.
European Medicines Agency (EMA): Approved for pneumonia and UTIs.
Other Agencies: Approved globally for antibiotic use; consult local guidelines.
References
- U.S. Food and Drug Administration (FDA). (2025). Maxipime (Cefepime) Prescribing Information.
- Official FDA documentation detailing the drug’s approved uses, dosage, and safety.
- European Medicines Agency (EMA). (2025). Cefepime Summary of Product Characteristics.
- EMA’s comprehensive information on the medication’s indications and precautions in Europe.
- National Institutes of Health (NIH). (2025). Cefepime: MedlinePlus Drug Information.
- NIH resource providing detailed information on the drug’s uses, side effects, and precautions.
- World Health Organization (WHO). (2025). WHO Model List of Essential Medicines: Cefepime.
- WHO’s consideration of Cefepime for infections.
- Antimicrobial Agents and Chemotherapy. (2024). Cefepime in Severe Infections.
- Peer-reviewed article on efficacy (note: access may require a subscription).
