Dosing & Uses
Dosage Forms & Strengths
infusion solution
- 1g/50mL
- 2g/100mL
powder for injection
- 1g
- 2g
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
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (3)
- BCG vaccine live
cefepime decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- cholera vaccine
cefepime, cholera vaccine. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid coadministration of cholera vaccine with systemic antibiotics since these agents may be active against the vaccine strain. Do not administer cholera vaccine to patients who have received oral or parenteral antibiotics within 14 days prior to vaccination.
- typhoid vaccine live
cefepime decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
Monitor Closely (9)
- amifampridine
cefepime increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.
- bazedoxifene/conjugated estrogens
cefepime will decrease the level or effect of bazedoxifene/conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- dienogest/estradiol valerate
cefepime will decrease the level or effect of dienogest/estradiol valerate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. An alternate or additional form of birth control may be advisable during concomitant use.
- estradiol
cefepime will decrease the level or effect of estradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- ethinylestradiol
cefepime will decrease the level or effect of ethinylestradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- levonorgestrel oral/ethinylestradiol/ferrous bisglycinate
cefepime will decrease the level or effect of levonorgestrel oral/ethinylestradiol/ferrous bisglycinate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. Antibiotics may decrease hormonal contraceptive efficacy.
- probenecid
probenecid will increase the level or effect of cefepime by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.
- sodium picosulfate/magnesium oxide/anhydrous citric acid
cefepime decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- warfarin
cefepime increases effects of warfarin by unspecified interaction mechanism. Use Caution/Monitor.
Minor (10)
- aminohippurate sodium
cefepime will increase the level or effect of aminohippurate sodium by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- aspirin
cefepime will increase the level or effect of aspirin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- aspirin rectal
cefepime will increase the level or effect of aspirin rectal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- aspirin/citric acid/sodium bicarbonate
cefepime will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- choline magnesium trisalicylate
cefepime will increase the level or effect of choline magnesium trisalicylate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- furosemide
cefepime increases toxicity of furosemide by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of nephrotoxicity.
- rose hips
rose hips will increase the level or effect of cefepime by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- sulfasalazine
cefepime will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- tolmetin
cefepime will increase the level or effect of tolmetin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- willow bark
cefepime will increase the level or effect of willow bark by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
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 (disturbance of consciousness including confusion, hallucinations, stupor, and coma), aphasia, myoclonus, seizures, and nonconvulsive status epilepticus
Anaphylaxis (anaphylactic shock, transient leukopenia, neutropenia, agranulocytosis, and thrombocytopenia)
Stevens-Johnson syndrome, erythema multiforme, toxic epidermal necrolysis, renal impairment, toxic nephropathy, aplastic anemia, hemolytic anemia, hemorrhage, hepatic impairment including cholestasis, and pancytopenia
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
Prescribing drug in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to patient and increases risk of development of drug-resistant bacteria
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; exercise caution if product is to be given to penicillin-sensitive patients; cross-hypersensitivity among beta-lactam antibacterials documented to occur up to 10% of patients with history of penicillin allergy; if allergic reaction to this drug occurs, discontinue drug and institute appropriate supportive measures
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
- Neurotoxicity has been reported, including life-threatening or fatal occurrences such as aphasia, encephalopathy, myoclonus, seizures, and nonconvulsive status epilepticus
- Most cases occurred in patients with renal impairment who did not receive appropriate dosage adjustment; however, some cases of neurotoxicity occurred in patients receiving a dosage adjustment appropriate for their degree of renal impairment
- In majority of cases, symptoms of neurotoxicity were reversible and resolved after discontinuation of therapy and/or after hemodialysis; if neurotoxicity associated with cefepime therapy occurs, discontinue therapy and institute appropriate supportive measures
Clostridioides difficile
- Clostridioides difficile-associated diarrhea (CDAD) may occur and should be considered in all patients who present with persistent diarrhea after use
- Careful medical history is necessary since CDAD has been reported to occur over two months after administration of antibacterial agents
- C. difficile produces toxins A and B, which contribute to development of CDAD
- Hypertoxin-producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy
- Careful medical history is necessary since CDAD has been reported to occur over two months after administration of antibacterial agents
- If CDAD is suspected or confirmed, ongoing antibacterial drug use not directed against C. difficile may need to be discontinued
- Appropriate fluid and electrolyte management, protein supplementation, antibacterial drug treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated
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
Pregnancy & Lactation
Pregnancy
There are no cases of drug exposure during pregnancy reported from postmarketing experience or from clinical trials; available data from published observational studies and case reports over several decades with cephalosporin use in pregnant women have not established drug-associated risks of major birth defects, miscarriage or adverse maternal or fetal outcomes
Animal data
- Cefepime was not associated with adverse developmental outcomes in rats, mice, or rabbits when administered parenterally during period of organogenesis; the doses used in these studies were 1.6 times (rats), approximately equal to (mice) and 0.3 times (rabbits) the maximum recommended clinical dose
Lactation
Drug is present in human milk at low concentration (0.5 mcg/mL); a nursing infant consuming approximately 1000 mL of human milk per day would receive approximately 0.5 mg of cefepime per day
There is no information regarding effects on milk production or on breastfed infant
Developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for cefepime and any potential adverse effects on breastfed child from drug or from underlying maternal condition
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.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)
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
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| cefepime injection - | 2 gram vial |  | |
| cefepime injection - | 2 gram vial |  | |
| cefepime injection - | 1 gram vial |  | |
| cefepime injection - | 2 gram vial |  | |
| cefepime injection - | 2 gram vial |  | |
| cefepime injection - | 1 gram vial |  | |
| cefepime injection - | 1 gram vial |  | |
| cefepime injection - | 2 gram vial |  | |
| cefepime injection - | 1 gram vial |  | |
| cefepime injection - | 1 gram vial |  | |
| cefepime injection - | 2 gram vial |  | |
| cefepime injection - | 1 gram vial |  | |
| cefepime injection - | 1 gram vial |  | |
| cefepime injection - | 2 gram vial |  | |
| cefepime injection - | 1 gram vial |  | |
| cefepime injection - | 1 gram vial |  | |
| cefepime injection - | 2 gram vial |  | |
| cefepime injection - | 2 gram vial |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
cefepime injection
CEFEPIME - INJECTION
(SEF-e-peem)
COMMON BRAND NAME(S): Maxipime
USES: Cefepime is used to treat a wide variety of bacterial infections. This medication belongs to a class of drugs known as cephalosporin antibiotics. It works by stopping the growth of bacteria.
HOW TO USE: This medication is given by injection into a muscle or vein as directed by your doctor. The dosage is based on your medical condition and response to treatment. For children, the dosage is also based on weight.If you are using this medication at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.If you are using the frozen pre-mixed solution, thaw the bag at room temperature or in the refrigerator. If the bag is thawed in the refrigerator, let it sit at room temperature at least 1 hour before using. Do not thaw by putting in a water bath or microwaving. After thawing, shake well and squeeze the bag to check for leaks. Discard solution if the bag leaks. Do not re-freeze the solution after thawing.For the best effect, use this antibiotic at evenly spaced times. To help you remember, use this medication at the same time(s) every day.Continue to use this medication for the full time prescribed, even if symptoms disappear after a few days. Stopping the medication too early may result in a return of the infection.Tell your doctor if your condition lasts or gets worse.
SIDE EFFECTS: Swelling, redness, or pain at the injection site may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: easy bruising/bleeding, unusual tiredness, uncontrollable movements, mental/mood changes (such as confusion, hallucinations, decreased alertness), seizures, trouble speaking, signs of kidney problems (such as change in the amount of urine), signs of liver problems (such as nausea/vomiting that doesn't stop, loss of appetite, stomach/abdominal pain, yellowing eyes/skin, dark urine).This medication may rarely cause a severe intestinal condition due to a bacteria called C. difficile. This condition may occur during treatment or weeks to months after treatment has stopped. Tell your doctor right away if you develop: diarrhea that doesn't stop, abdominal or stomach pain/cramping, blood/mucus in your stool.If you have these symptoms, do not use anti-diarrhea or opioid products because they may make symptoms worse.Use of this medication for prolonged or repeated periods may result in oral thrush or a new yeast infection. Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge, or other new symptoms.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before using cefepime, tell your doctor or pharmacist if you are allergic to it; or to other antibiotics (such as penicillins, other cephalosporins); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, stomach/intestinal diseases (such as colitis).Cefepime may cause live bacterial vaccines (such as typhoid vaccine) to not work well. Tell your health care professional that you are using cefepime before having any immunizations/vaccinations.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Tell your doctor if you are pregnant before using this medication.This medication passes into breast milk in small amounts and is unlikely to harm a nursing infant. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.This medication may interfere with certain lab tests (including certain urine glucose tests), possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: seizures.
NOTES: Do not share this medication with others.Lab and/or medical tests (such as complete blood count, kidney function tests) should be done while you are using this medication. Keep all medical and lab appointments.
MISSED DOSE: It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule. Do not double the dose to catch up.
STORAGE: Consult the product instructions and your pharmacist for storage details. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised April 2022. Copyright(c) 2022 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
Adding plans allows you to compare formulary status to other drugs in the same class.
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.
