cefepime hydrochloride

Action

Interferes with bacterial cell-wall synthesis and division by binding to cell wall, causing cell to die. Active against gram-negative and gram-positive bacteria, with expanded activity against gram-negative bacteria. Exhibits minimal immunosuppressant activity.

Availability

Powder for injection: 500-mg vial, 1-g vial, 2-g vial; 1-g and 2-g piggyback bottles

Solution for injection (premixed): 1 g (50 ml in iso-osmotic dextrose), 2 g (100 ml in iso-osmotic dextrose)

Indications and dosages

➣ Urinary tract infections (UTIs) caused by Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis

Adults: 500 mg to 1g by I.V. infusion or I.M. q 12 hours for 7 to 10 days

➣ Severe UTIs caused by E. coli or K. pneumoniae; moderate to severe skin infections caused by Staphylococcus aureus or Streptococcus pyogenes

Adults: 2 g by I.V. infusion q 12 hours for 10 days

➣ Febrile neutropenia

Adults and children ages 2 months to 16 years: 2 g by I.V. infusion q 8 hours for 7 days

➣ Complicated intra-abdominal infections caused by alpha-hemolytic streptococci, E. coli, K. pneumoniae, Pseudomonas aeruginosa, Enterobacter species, or Bacteroides fragilis

Adults: 2 g by I.V. infusion q 12 hours for 7 to 10 days (given with metronidazole)

➣ Moderate to severe pneumonia caused by K. pneumoniae, P. aeruginosa, Enterobacter species, or Streptococcus pneumoniae

Adults: 1 to 2 g by I.V. infusion q 12 hours for 10 days

Dosage adjustment

• Renal impairment

Contraindications

• Hypersensitivity to cephalosporins or penicillins

Precautions

Use cautiously in:

• renal impairment, phenylketonuria

• history of GI disease

• elderly patients

• pregnant or breastfeeding patients

• children.

Administration

• Don't mix premixed solution with other drugs.

See Don't use flexible container in series connections because of risk of air embolism.

• Obtain specimens for culture and sensitivity testing as needed before starting therapy.

• Don't mix with ampicillin (at concentrations above 40 mg/ml), metronidazole, aminoglycosides, or aminophylline if ordered concurrently. Give each drug separately.

• For I.V. infusion, use small I.V. needle and infuse into large vein over 30 to 60 minutes.

• For I.M. administration, inject deep into large muscle.

Adverse reactions

CNS: headache, lethargy, paresthesia, syncope, seizures

CV: phlebitis, hypotension, palpitations, chest pain, vasodilation, thrombophlebitis

EENT: hearing loss

GI: nausea, vomiting, diarrhea, abdominal cramps, oral candidiasis, pseudomembranous colitis

GU: vaginal candidiasis, nephrotoxicity

Hematologic: lymphocytosis, eosinophilia, bleeding tendency, hemolytic anemia, hypoprothrombinemia, neutropenia, thrombocytopenia, agranulocytosis, bone marrow depression

Hepatic: hepatic failure, hepatomegaly

Musculoskeletal: arthralgia

Respiratory: dyspnea

Skin: urticaria, maculopapular or erythematous rash, redness, swelling, induration

Other: chills, fever, superinfection, pain at I.M. site, phlebitis at I.V. site, anaphylaxis, serum sickness

Interactions

Drug-drug. Aminoglycosides, loop diuretics: increased risk of nephrotoxicity

Probenecid: decreased excretion and increased blood level of cefepime

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, blood urea nitrogen, creatinine, eosinophils, gamma-glutamyltransferase, lactate dehydrogenase: increased levels
Coombs' test, urinary 17-ketosteroids, nonenzyme-based urine glucose tests (such as Clinitest): false-positive results

Hemoglobin, platelets, white blood cells: decreased values

Drug-herbs. Angelica, anise, arnica, asafetida, bogbean, boldo, celery, chamomile, clove, danshen, fenugreek, feverfew, garlic, ginger, ginkgo, ginseng, horse chestnut, horseradish, licorice, meadowsweet, onion, papain, passionflower, poplar, prickly ash, quassia, red clover, turmeric, wild carrot, wild lettuce, willow: increased risk of bleeding

Patient monitoring

• Assess baseline CBC and kidney and liver function test results.

• Monitor for signs and symptoms of superinfection and other serious adverse reactions.

• Monitor for inflammation at infusion site.

• Be aware that cross-sensitivity to penicillins may occur.

Patient teaching

• Instruct patient to report reduced urinary output, persistent diarrhea, bruising, petechiae, or bleeding.

• Caution patient not to take herbs without consulting prescriber.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.