cefepime

Cefepime is a fourth-generation cephalosporin antibiotic that inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins. It has broad spectrum activity against many Gram-positive cocci, including Streptococcus species and methicillin-susceptible Staphylococcus aureus, and against a wide range of Gram-negative bacteria, including Enterobacterales and Pseudomonas aeruginosa. Its activity against anaerobes is limited. Cefepime is more resistant to many beta-lactamases than earlier cephalosporins but can be inactivated by extended-spectrum beta-lactamases and AmpC enzymes. It is not reliably active against MRSA or Enterococcus species.

In clinical use, cefepime is employed for moderately to severely ill inpatients with nosocomial or complicated infections, including pneumonia, intra-abdominal infections, urinary tract infections, skin and soft tissue infections, and sepsis. It is sometimes used for empiric therapy when Pseudomonas infection is suspected and can be considered for central nervous system infections when meningitis is inflamed because of its CNS penetration.

Administration and dosing: Cefepime is given by intravenous or intramuscular injection. Dosing is adjusted for renal function; higher doses or more frequent administration are needed in renal impairment. In adults, regimens commonly include 1–2 g every 8–12 hours for moderate infections, with higher dosing for pneumonia or febrile neutropenia. Pediatric dosing is weight-based.

Adverse effects and safety: Common adverse effects include infusion-site reactions, diarrhea, nausea, rash, and hypersensitivity. Clostridioides difficile infection risk exists. Cefepime can cause seizures or encephalopathy in patients with renal impairment or when overdosed. Potential drug interactions include probenecid and other nephrotoxic agents.