Cefepime
MAXIPIME
What it isPBP-inhibiting fourth-generation cephalosporin; febrile neutropenia and serious pseudomonal infection.
Why this oneIt combines 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.
FDA-approved for
- serious infections (1996)
FDA label
Read the full label on DailyMed ↗
| 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
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)
NO BOXED WARNINGS
Principal riskNeurotoxicity if not renally dosed
Cost, est. cash$300–$2,500/month
Generic entryLong generic
Classes and tags
Clinical profile
Legacy pregnancy categoryB
Defining liabilityAllergy, gastrointestinal effects and agent-specific renal, hepatic, hematologic or interaction risks.
Mechanism of action: Cefepime ballicule
