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cefepime (Rx)Brand and Other Names:Maxipime

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

infusion solution

  • 1g/50mL
  • 2g/100mL

powder for injection

  • 1g
  • 2g
more...

Pneumonia

Treatment of moderate-to-severe pneumonia

1-2 g IV q8-12hr for 7-10 days (if not caused by Pseudomonas) or for up to 21 days (if caused by Pseudomonas)

Febrile Neutropenia

Empiric therapy in febrile neutropenic patients

2 g IV q8hr for 7 days or until neutropenia resolves

Urinary Tract Infections

Treatment of uncomplicated and complicated urinary tract infections (UTIs), including pyelonephritis

0.5-1 g IV or IM q12hr for 7-10 days

Severe UTIs due to Escherichia coli or Klebsiella pneumoniae: 2 g IV q12hr for 10 days

Skin/Skin Structure Infections

Treatment of uncomplicated skin and skin structure infections

2 g IV q12hr for 10 days

Intra-abdominal Infections

Treatment of complicated intra-abdominal infections; use in combination with metronidazole

2 g IV q12hr for 7-10 days

Dosing Modifications

Adjust recommended maintenance dosages according to CrCl

Recommended maintenance dosage 500 mg q12hr

  • CrCl >60 mL/min: 500 mg q12hr
  • CrCl 30-60 mL/min: 500 mg q24hr
  • CrCl 11-29 mL/min: 500 q24hr
  • CrCl <11 mL/min: 250 q24hr
  • Continuous ambulatory peritoneal dialysis (CAPD): 500 mg q48hr
  • Hemodialysis: 1 g on day 1, then 500-1000 mg q24hr thereafter (on hemodialysis days, administer after hemodialysis)

Recommended maintenance dosage 1 g q12hr

  • CrCl >60 mL/min: 1 g q12hr
  • CrCl 30-60 mL/min: 1 g q24hr
  • CrCl 11-29 mL/min: 500 mg q24hr
  • CrCl <11 mL/min: 250 mg q24hr
  • CAPD: 1 g q48hr
  • Hemodialysis: 1 g on day 1, then 500 mg q24hr thereafter (on hemodialysis days, administer after hemodialysis)

Recommended maintenance dosage 2 g q12hr

  • CrCl >60 mL/min: 2 g q12hr
  • CrCl 30-60 mL/min: 2 g q24hr
  • CrCl 11-29 mL/min: 1 g q24hr
  • CrCl <11 mL/min: 500 mg q24hr
  • CAPD: 2 g q48hr
  • Hemodialysis: 1 g on day 1, then 500 mg q24hr thereafter (on hemodialysis days, administer after hemodialysis)

Recommended maintenance dosage 2 g q8hr

  • CrCl >60 mL/min: 2 g q8hr
  • CrCl 30-60 mL/min: 2 g q12hr
  • CrCl 11-29 mL/min: 2 g q24hr
  • CrCl <11 mL/min: 1 g q24hr
  • CAPD: 2 g q48hr
  • Hemodialysis: 1 g q24hr (on hemodialysis days, administer after hemodialysis)

Dosing Considerations

Susceptible organisms

  • Bacteroides spp, Enterobacter spp, Escherichia coli, Haemophilus influenzae, Klebsiella spp, Proteus mirabilis, Pseudomonas spp, Staphylococcus aureus, Streptococcus pyogenes

Dosage Forms & Strengths

infusion solution

  • 1g/50mL
  • 2g/100mL

powder for injection

  • 1g
  • 2g
more...

Febrile Neutropenia

Empiric therapy in febrile neutropenic patients

>2 months, <40 kg: 50 mg/kg IV q8hr for 7 days or until neutropenia resolves; not to exceed 2 g q8hr  

Pneumonia

Treatment of moderate-to-severe pneumonia

50 mg/kg IV q12hr for 10 days; not to exceed 2 g q12hr  

Skin/Skin Structure Infections

Treatment of uncomplicated skin and skin structure infections

50 mg/kg IV q12hr for 10 days; not to exceed 2 g q12hr 

Urinary Tract Infections

Treatment of uncomplicated and complicated UTIs, including pyelonephritis

50 mg/kg IV/IM q12hr for 7-10 days; not to exceed 2 g q12hr 

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Interactions

Interaction Checker

cefepime and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Positive Coombs test result without hemolysis (16%)

            1-10%

            Rash (1-4%)

            Elevated alanine aminotransferase (3%)

            Hypophosphatemia (3%)

            Diarrhea (<3%)

            Eosinophilia (2%)

            Erythema at injection site (2%)

            Normal partial thromboplastin time (PTT) (2%)

            Nausea or vomiting (<2%)

            Fever (1%)

            Headache (1%)

            Pain (1%)

            Pruritus (1%)

            <1%

            Agranulocytosis

            Anaphylactic shock

            Anaphylaxis

            Coma

            Encephalopathy

            Hallucinations

            Leukopenia

            Myoclonus

            Neuromuscular excitability

            Neutropenia

            Seizures

            Thrombocytopenia

            Postmarketing Reports

            Neurotoxicity: Encephalopathy, aphasia, nonconvulsive status epilepticus

            Other: Anaphylaxis (including anaphylactic shock), transient leukopenia

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            Warnings

            Contraindications

            Documented hypersensitivity to cefepime, penicillins, or other beta-lactam antibiotics

            Cautions

            IM recommended only for mild-to-moderate complicated or uncomplicated UTI due to E coli

            Prolonged use may cause superinfection

            May increase international normalized ratio (INR) with prolonged treatment, especially in nutritionally deficient patients

            Caution warranted with history of previous immediate hypersensitivity reactions to cefepime, cephalosporins, penicillins, or other drugs

            Clostridium difficile-associated diarrhea (CDAD) may occur and should be considered in all patients who present with persistent diarrhea after use

            Use with caution in patients with GI disease, particularly colitis

            If CrCl <60 mL/min, adjust dosage to compensate for slower renal elimination rate

            Neurotoxicity has been reported, including life-threatening or fatal occurrences such as aphasia, encephalopathy, myoclonus, seizures, and nonconvulsive status epilepticus

            Nonconvulsive status epilepticus

            • Risk of nonconvulsive status epilepticus may be increased if inadequate dosing adjustment is made with renal impairment
            • Most cases occurred in patients with renal impairment who did not receive appropriate dosage adjustment; however, some occurred in patients receiving dosage adjustment appropriate for their degree of renal impairment
            • Signs and symptoms of nonconvulsive status epilepticus may include altered mental status, confusion, and decreased responsiveness
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            Pregnancy & Lactation

            Pregnancy category: B

            Lactation: Drug enters breast milk; use with caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Fourth-generation cephalosporin; has gram-negative coverage comparable to ceftazidime but better gram-positive coverage (comparable to ceftriaxone); is zwitterion and rapidly penetrates gram-negative cells; is best beta-lactam for IM administration; has poor capacity to cross blood-brain barrier and thus is not used for treatment of meningitis

            Absorption

            IM absorption rapid and complete

            Peak plasma time: 0.5-1.5 hr (IV); 1-2 hr (IM)

            Distribution

            Penetrates into inflammatory fluid at concentrations ~80% of serum levels and into bronchial mucosa at concentrations ~60% of plasma levels; crosses blood-brain barrier

            Protein bound: 16-19%

            Vd: 16-20 L (adults)

            Metabolism

            Minimally metabolized in liver

            Elimination

            Half-life: 2 hr

            Excretion: Urine (85% as unchanged drug)

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            Administration

            IV Incompatibilities

            Additive: Aminophylline, ampicillin(?), gentamicin, netilmicin, tobramycin

            Y-site: Acyclovir, amphotericin B, amphotericin B cholesteryl sulfate, chlordiazepoxide, chlorpromazine, cimetidine, ciprofloxacin, cisplatin, dacarbazine, daunorubicin, diazepam, diphenhydramine, dobutamine, dopamine, doxorubicin, droperidol, enalaprilat, etoposide, etoposide phosphate, famotidine, filgrastim, floxuridine, ganciclovir, haloperidol, hydroxyzine, idarubicin, ifosfamide, magnesium sulfate, mannitol, mechlorethamine, meperidine, metoclopramide, mitomycin, mitoxantrone, morphine, nalbuphine, ofloxacin, ondansetron, plicamycin, prochlorperazine, promethazine, streptozocin, vancomycin, vinblastine, vincristine

            IV Compatibilities

            Solution compatible with most common solvents

            Additive: Amikacin, clindamycin, heparin, metronidazole(?), potassium chloride, theophylline, vancomycin

            Y-site (partial list): Ampicillin-sulbactam, calcium gluconate, carboplatin, dexamethasone sodium phosphate, fluconazole, fluorouracil, metronidazole, milrinone, propofol, sodium bicarbonate, trimethoprim-sulfamethoxazole (TMP-SMX)

            IV Preparation

            Reconstitute with 50-100 mL of NS, D5W, D10W, LR, D5/LR, or other compatible fluid

            Thaw infusion solution at room temperature or in refrigerator, not in water bath or microwave oven

            IV Administration

            Infuse intermittently over 30 minutes

            Do not administer other drugs through Y-site

            IM Preparation

            Add 2.4 mL of appropriate diluent (SWI, NS, D5W etc) to 1 g vial to yield solution containing approximately 280 mg/mL

            IM Administration

            Inject deeply

            Give IM only in mild-to-moderate UTI due to E coli

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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