KEY POINTS
- Cefepime (Maxipime) is a fourth-generation cephalosporin and beta-lactam antibiotic that interferes with cell wall synthesis of susceptible bacteria
- Time-dependent killer, so the longer the time above the MIC during the dosing interval, the more killing
- Possess activity against a wide array of Gram negative bacteria, including Pseudomonas aeruginosa
- Possess activity against many Gram positive bacteria, including MSSA but not MRSA
- Can consider adding metronidazole (Flagyl) to cefepime if anaerobic coverage is needed
- A go-to anti-pseudomonas drug for neutropenic fever treatment
- Is also expected to cause less aspergillum galactomannan assay false-positives than piperacillin-tazobactam
- Adjust dose/schedule for renal dysfunction
- Can be given by prolonged infusion (e.g., over 4 hours)
- Can be given as 2/2/3 dosing in intermittent hemodialysis patients
- Has been associated with neurotoxicity
- Only available as injectable
RESOURCES
- Cefepime Package Insert
- FDA Cefepime Safety Information
- FDA Cefepime Information
- Mayo Clinic 1999 Cephalosporin Review
- IDSA Practice Guidelines
- Surgical Prophylaxis Guidelines
- Cefepime-induced neurotoxicity: systematic review (2022)
- Characterizing Cefepime Neurotoxicity: A Systematic Review (OFID, 2017)
- Extended-Infusion Cefepime Reduces Mortality in Patients with Pseudomonas aeruginosa Infections (AAC 2013)
- Three-times-weekly, post-dialysis cefepime therapy in patients on maintenance hemodialysis: a retrospective study
- False-positive serum and bronchoalveolar lavage Aspergillus galactomannan assays caused by different antibiotics
