Cefepime

MAXIPIME

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Pronunciation: SEF-e-peem

Cefepime ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Cefepime ballicule

What it isPBP-inhibiting fourth-generation cephalosporin; febrile neutropenia and serious pseudomonal infection.

Why this oneCombines pseudomonal cover with stability against AmpC beta-lactamases, which ceftriaxone lacks.

What limits it⚑ Neurotoxicity with encephalopathy or nonconvulsive status occurs when renal dosing is missed. No MRSA or anaerobic cover.

Cefepime molecular structure (skeletal formula) — Molecular structure: Cefepime

FDA-approved for

serious infections (1996)

Principal riskNeurotoxicity if not renally dosed

Classes and tags

Clinical profile

Therapeutic safety burden2 / 4

Overdose danger1 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk0 / 4

Legacy pregnancy categoryB

Defining liabilityAllergy, gastrointestinal effects and agent-specific renal, hepatic, hematologic or interaction risks.

FDA label

Read the full label on DailyMed ↗

NO BOXED WARNINGS

FDA dosing	Population	Start	Target	Max
Moderate–severe pneumonia	Adults (CrCl >60)	1–2 g IV q8–12h ×10 days	1–2 g IV q8–12h (2 g q8h for P. aeruginosa)	2 g q8h
Empiric therapy, febrile neutropenia	Adults	2 g IV q8h ×7 days	2 g IV q8h	2 g q8h
Mild–moderate UTI (incl. pyelonephritis)	Adults	0.5–1 g IV/IM q12h ×7–10 days	0.5–1 g IV/IM q12h
Severe UTI (incl. pyelonephritis)	Adults	2 g IV q12h ×10 days	2 g IV q12h
Moderate–severe uncomplicated skin/skin-structure	Adults	2 g IV q12h ×10 days	2 g IV q12h
Complicated intra-abdominal (with metronidazole)	Adults	2 g IV q8–12h ×7–10 days	2 g IV q8–12h
General infections	Children 2 mo–16 y (≤40 kg)	50 mg/kg/dose q12h (q8h for P. aeruginosa/febrile neutropenia)	50 mg/kg/dose q12h–q8h	not to exceed adult dose

Renal Adjust for CrCl ≤60 mL/min (see label tables: extend interval / reduce dose). Hemodialysis: 1 g day 1 then 500 mg q24h (1 g q24h for febrile neutropenia), dosed after dialysis. CAPD: dose q48h

Hepatic Undefined

Instructions

IV infusion over ~30 minutes
IM route only for mild–moderate UTI due to E. coli

Available strengths

inj 500, 1000, 2000 mg

Cautions

Neurotoxicity (encephalopathy, aphasia, myoclonus, seizures, nonconvulsive status epilepticus), especially in renal impairment without dose adjustment
Hypersensitivity; cross-reactivity up to 10% in penicillin-allergic patients
CDAD
Positive Coombs; hemolytic anemia — discontinue if it develops
Fall in prothrombin activity; monitor PT

Adverse reactions

Local reactions/phlebitis; rash
Positive Coombs test (without hemolysis, ~16%); decreased phosphorus; increased ALT/AST, PT/PTT
Diarrhea, nausea, vomiting, pruritus, fever, headache (higher at 2 g q8h)
Colitis, oral moniliasis, vaginitis, anemia

Pregnancy No established drug-associated risks; not embryocidal/teratogenic in animals

Lactation Present in human breast milk at low concentration (~0.5 mcg/mL after a 1000 mg IV dose)

Cost

Cefepime (MAXIPIME)

What pharmacies pay · NADAC 9/30/26

Strength		#/mo	generic $/unit	CostPlus
500 mg	inj	per unit		not offered
1000 mg	inj	per unit	$3.73/ea	not offered
2000 mg	inj	per unit		not offered

Generic entryLong generic

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Self-check

What can occur if cefepime renal dosing is missed?
Encephalopathy or nonconvulsive status.
Which beta-lactamase stability distinguishes cefepime from ceftriaxone?
AmpC stability.