CEFEPIME HYDROCHLORIDE

CEFEPIME HYDROCHLORIDE
(cef'e-peem)
Maxipime
Classifications: antibiotic; fourth-generation cephalosporin;
Therapeutic: antibiotic
; cephalosporin
Prototype: Cefotaxime sodium
Pregnancy Category: B

Availability

500 mg, 1 g, 2 g vials

Action

Cefepime, considered to be a fourth-generation cephalosporin antibiotic that preferentially binds to one or more of the penicillin-binding proteins (PBPs) located on cell walls of susceptible organisms. This inhibits the third and final stage of bacterial cell wall synthesis, thus killing the bacteria (bactericidal).

Therapeutic Effect

Cefepime is similar to third-generation cephalosporins with respect to broad gram-negative coverage; however, cefepime has broader gram-positive coverage than third-generation cephalosporins. It is highly resistant to hydrolysis by most beta-lactamase bacteria.

Uses

Uncomplicated and complicated UTI, skin and soft tissue infections, pneumonia caused by susceptible organisms. Empiric monotherapy for febrile neutropenic patients.

Contraindications

Hypersensitivity to cefepime, other cephalosporins, severe reaction to penicillins, or other beta-lactam antibiotics.

Cautious Use

Patients with history of GI disease, particularly colitis; renal insufficiency; pregnancy (category B), lactation. Safety and efficacy of cefepime in children <12 y not known.

Route & Dosage

Mild to Moderate Infections
Adult: IV/IM 0.5–1g q12h for 7–10 d

Moderate to Severe Infections
Adult: IV 1–2g q12h for 10 d

Febrile Neutropenia
Adult: IV 2 g q8h for 7 d or until resolution of neutropenia
Child: IV 50 mg/kg q8h until resolution of neutropenia

UTI/Pneumonia
Child: IV 50 mg/kg q12h for 7–10 d

Renal Impairment
Clcr 30–60 mL/min: dose q24h; 11–29 mL/min: give 50% of normal dose q24h; <10 mL/min: 250–500 mg q24h
Hemodialysis: Administer dose after dialysis

Administration

Intramuscular
  • Reconstitute 500-mg vial and 1-g vial, respectively, with 1.3 or 2.4 mL of one of the following: Sterile Water for Injection, 0.9% NaCl Injection, Bacteriostatic Water for Injection with Parabens or benzyl alcohol, or other compatible solution.
Intravenous

PREPARE: Intermittent: Dilute with 50–100 mL of one of the following: NS, D5W, D5/NS or other compatible solution.  

ADMINISTER: Intermittent: Infuse over 30 min; with Y-type administration set, discontinue other compatible solutions while infusing cefepime.  

INCOMPATIBILITIES Solution/additive: aminoglycosides, ampicillin, aminophylline, metronidazole. Y-site: Acyclovir, amphotericin B, amphotericin B cholesteryl complex, chlordiazepoxide, chlorpromazine, cimetidine, ciprofloxacin, cisplatin, dacarbazine, daunorubicin, diazepam, diphenhydramine, dobutamine, dopamine, doxorubicin, droperidol, enalaprilat, etoposide, 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.

  • Store reconstituted solution at 20°–25° C (68°–77° F) for 24 h or in refrigerator at 2°–8° C (36°–46° F) for 7 days. Protect from light.

Adverse Effects (≥1%)

Body as a Whole: Eosinophilia. GI: Antibiotic-associated colitis, diarrhea, nausea, oral moniliasis, vomiting, elevated liver function tests (ALT, AST). CNS: Headache, fever. Skin: Phlebitis, pain, inflammation, rash, pruritus, urticaria. Urogenital: Vaginitis.

Diagnostic Test Interference

Positive Coombs' test without hemolysis. May cause false-positive urine glucose test with Clinitest.

Interactions

Drug: aminoglycosides may increase risk of nephrotoxicity and have additive/synergistic effects. May decrease efficacy of oral contraceptives. Probenecid may increase levels.

Pharmacokinetics

Absorption: Well absorbed after IM administration; serum levels significantly lower than after equivalent IV dose. Distribution: Widely distributed, may cross inflamed meninges; crosses placenta, secreted into breast milk. Metabolism: In liver. Elimination: In urine. Half-Life: 2 h.

Nursing Implications

Assessment & Drug Effects

  • Determine history of hypersensitivity reactions to cephalosporins, penicillins, or other drugs before therapy is initiated.
  • Lab tests: Perform culture and sensitivity tests before initiation of therapy. Dosage may be started pending test results.
  • Monitor for S&S of hypersensitivity (see Appendix F). Report their appearance promptly and discontinue drug.
  • Monitor for S&S of superinfection or pseudomembranous colitis (see Appendix F); immediately report either to physician.
  • With concurrent high-dose aminoglycoside therapy, closely monitor for nephrotoxicity and ototoxicity.

Patient & Family Education

  • Promptly report any S&S of hypersensitivity, superinfection, and pseudomembranous colitis.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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