Cefepime Hydrochloride and alcohol

• Generic Name: cefepime
• Dosage Forms: n.a.
• Other Brand Names: Maxipime, Maxipime ADD-Vantage

Treatment of complicated intra-abdominal infections caused by Escherichia coli, viridans streptococci, Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterobacter, or Bacteroides fragilis; used in conjunction with IV metronidazole.

For initial empiric treatment of high-risk or severe community-acquired extrabiliary intra-abdominal infections in adults, IDSA recommends either monotherapy with a carbapenem (doripenem, imipenem, meropenem) or the fixed combination of piperacillin and tazobactam, or a combination regimen that includes either a cephalosporin (cefepime, ceftazidime) or fluoroquinolone (ciprofloxacin, levofloxacin) in conjunction with metronidazole.

Has been used alone for treatment of acute obstetric and gynecologic infections (e.g., pelvic inflammatory disease [PID], pelvic surgical wound infection, postpartum endometritis), but safety and efficacy of cefepime monotherapy in these infections not established.

Treatment of moderate to severe pneumonia (with or without concurrent bacteremia) caused by susceptible Streptococcus pneumoniae.

Treatment of moderate to severe pneumonia caused by susceptible Ps. aeruginosa, K. pneumoniae, or Enterobacter.

Treatment of community-acquired pneumonia (CAP) caused by S. pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus. ATS and IDSA recommend cefepime for treatment of CAP only when Ps. aeruginosa is known or suspected to be involved. For empiric treatment of CAP in patients with risk factors for Ps. aeruginosa, IDSA and ATS recommend a combination regimen that includes an antipneumococcal, antipseudomonal β-lactam (cefepime, imipenem, meropenem, fixed combination of piperacillin and tazobactam) and ciprofloxacin or levofloxacin; one of these β-lactams, an aminoglycoside, and azithromycin; or one of these β-lactams, an aminoglycoside, and an antipneumococcal fluoroquinolone. If Ps. aeruginosa has been identified by appropriate microbiologic testing, these experts recommend treatment with a regimen that includes an antipseudomonal β-lactam (cefepime, ceftazidime, aztreonam, imipenem, meropenem, piperacillin, ticarcillin) and ciprofloxacin, levofloxacin, or an aminoglycoside.

Treatment of nosocomial pneumonia. For empiric treatment in severely ill patients or in those with late-onset disease or risk factor for multidrug-resistant bacteria, used in conjunction with either an aminoglycoside (amikacin, gentamicin, tobramycin) or an antipseudomonal fluoroquinolone (ciprofloxacin, levofloxacin). In hospitals where methicillin-resistant (oxacillin-resistant) Staphylococcus is common or if there are risk factors for these strains, initial regimen also should include vancomycin or linezolid.

Treatment of uncomplicated skin and skin structure infections caused by susceptible S. aureus (methicillin-susceptible [oxacillin-susceptible] strains only) or susceptible S. pyogenes (group A β-hemolytic streptococci).

Treatment of mild to moderate uncomplicated and complicated UTIs (including those associated with pyelonephritis and/or with concurrent bacteremia) caused by susceptible E. coli, K. pneumoniae, or Proteus mirabilis.

Treatment of severe uncomplicated and complicated UTIs (including those associated with pyelonephritis and/or concurrent bacteremia) caused by susceptible E. coli or K. pneumoniae.

Empiric treatment of culture-negative endocarditis in prosthetic valve recipients. AHA recommends multiple-drug regimen of vancomycin, gentamicin, cefepime, and rifampin for empiric treatment of culture-negative endocarditis with onset within 1 year of valve placement. Selection of the most appropriate anti-infective regimen is difficult and should be guided by epidemiologic features and clinical course of the infection. Consultation with an infectious diseases specialist recommended.

Treatment of meningitis caused by susceptible gram-negative bacteria (e.g., H. influenzae, Neisseria meningitidis, E. coli, E. aerogenes, Ps. aeruginosa) or gram-positive bacteria (e.g., S. pneumoniae, S. aureus, S. epidermidis).

Safety and efficacy not established. Manufacturers caution that patients in whom meningeal seeding from a distant infection site or in whom meningitis is suspected or documented should receive an alternative anti-infective with demonstrated clinical efficacy in this setting. Some clinicians state additional study needed regarding efficacy for treatment of meningitis, particularly for infections caused by penicillin- and/or cefotaxime-resistant S. pneumoniae. In addition, cefepime may not be a good choice for empiric treatment of meningitis if Acinetobacter may be involved.

IDSA states cefepime is one of several alternatives for treatment of meningitis caused by H. influenzae or E. coli or treatment of meningitis caused by S. pneumonia susceptible to penicillins and third generation cephalosporins. For treatment of meningitis caused by Ps. aeruginosa, IDSA and other experts recommend a regimen that includes an antipseudomonal cephalosporin (cefepime or ceftazidime) or carbapenem (imipenem or meropenem) given with or without an aminoglycoside (amikacin, gentamicin, tobramycin). Use results of in vitro susceptibility tests to guide treatment.

IDSA also recommends a regimen of cefepime and vancomycin as one of several options that can be used for empiric treatment of penetrating head trauma or postneurosurgical infections caused by S. aureus, coagulase-negative staphylococci (especially S. epidermidis), or aerobic gram-negative bacilli (including Ps. aeruginosa).

Treatment of septicemia caused by susceptible gram-negative bacteria.

Select anti-infective for treatment of sepsis syndrome based on probable source of infection, causative organism, immune status of patient, and local patterns of bacterial resistance.

For initial treatment of life-threatening sepsis in adults, some clinicians suggest that a third or fourth generation cephalosporin (cefepime, cefotaxime, ceftriaxone, ceftazidime), the fixed combination of piperacillin and tazobactam, or a carbapenem (imipenem or meropenem) be used in conjunction with vancomycin; some also suggest including an aminoglycoside or fluoroquinolone during initial few days of treatment.

Empiric treatment of presumed bacterial infections in febrile neutropenic patients.

Has been effective as monotherapy for empiric therapy in febrile neutropenic patients; used in conjunction with other anti-infectives in some patients. Manufacturers caution that safety and efficacy data limited to date and monotherapy may not be appropriate in patients at severe risk of infection (e.g., those with a history of recent bone marrow transplantation, hypotension on presentation, underlying hematologic malignancy, severe or prolonged neutropenia).

Consult published protocols on treatment of infections in febrile neutropenic patients for specific recommendations regarding selection of initial empiric regimen, when to change initial regimen, possible subsequent regimens, and duration of therapy in these patients. Consultation with an infectious disease expert knowledgeable about infections in immunocompromised patients also advised.