Pneumonia caused by susceptible strains of S. pneumoniae, P. aeruginosa, K. pneumoniae, or Enterobacter species. Empiric therapy for febrile neutropenic pts at high risk for severe infection. Uncomplicated/complicated UTIs (including pyelonephritis) caused by susceptible isolates of E. coli, K. pneumoniae, or P. mirabilis. Uncomplicated skin and skin structure infections caused by S. aureus (methicillin-susceptible isolates only) or S. pyogenes. Complicated intra-abdominal infections (used in combination With metronidazole) caused by susceptible isolates of E. coli, viridans group Streptococci, P. aeruginosa, K. pneumoniae, Enterobacter species, or B. fragilis. OFF-LABEL: Gram-negative bacteremia, acute pulmonary exacerbations in cystic fibrosis; diabetic foot infection, neutropenic fever (high-risk cancer pts), osteomyelitis, peritonitis, prosthetic joint infection, sepsis/septic shock, septic arthritis.
Contraindications: History of anaphylactic reaction to penicillins, hypersensitivity to cefepime, cephalosporins. Cautions: Renal impairment, history of seizure disorder, GI disease (colitis), elderly.
Binds to bacterial cell wall membranes, inhibits cell wall synthesis. Therapeutic Effect: Bactericidal.
Widely distributed. Protein binding: 20%. Primarily excreted in urine. Removed by hemodialysis. Half-life: 2–2.3 hrs (increased in renal impairment, elderly pts).
Pregnancy/Lactation: Unknown if distributed in breast milk. Children: No age-related precautions noted in pts older than 2 mos. Elderly: Age-related renal impairment may require reduced dosage or increased dosing interval. Elderly pts with renal insufficiency may have an increased risk of encephalopathy, seizures.
DRUG: Probenecid may increase concentration/effect. May increase concentration/effect of aminoglycosides. HERBAL: None significant. FOOD: None known. LAB VALUES: May increase serum BUN, alkaline phosphatase, bilirubin, LDH, ALT, AST. May cause positive direct/indirect Coombs' test.
IV
Reconstitution · Add 10 mL of diluent for 1-g and 2-g vials. · Further dilute with 50–100 mL 0.9% NaCl or D5W. Rate of administration · For intermittent IV infusion (piggyback), infuse over 30 min. For IV push, administer over 5 min.
Storage · Solution is stable for 24 hrs at room temperature, 7 days if refrigerated.
IM
Usual Dosage Range
IV: ADULTS, ELDERLY: 1–2 g q8–12h. CHILDREN: 50 mg/kg q8–12h. Maximum: 2,000 mg/dose. NEONATES: 30 mg/kg q12h up to 50 mg/kg q8–12h.
Dosage in Renal Impairment
Dosage and frequency are modified based on creatinine clearance and severity of infection.
Creatinine Clearance Dosage
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Dosage in Hepatic Impairment
No dose adjustment.
Frequent: Discomfort with IM administration, oral candidiasis (thrush), mild diarrhea, mild abdominal cramping, vaginal candidiasis. Occasional: Nausea, serum sickness–like reaction (fever, joint pain; usually occurs after second course of therapy and resolves after drug is discontinued). Rare: Allergic reaction (rash, pruritus, urticaria), thrombophlebitis (pain, redness, swelling at injection site).
Antibiotic-associated colitis, other superinfections (abdominal cramps, severe watery diarrhea, fever) may result from altered bacterial balance in GI tract. Nephrotoxicity may occur, esp. in pts with preexisting renal disease. Pts with history of penicillin allergy are at increased risk for developing a severe hypersensitivity reaction (severe pruritus, angioedema, bronchospasm, anaphylaxis).
Dexmedetomidine, insulin.
