Cefepime: Uses, Dosage, Side Effects, Interactions

Cefepime is a fourth-generation cephalosporin antibiotic used to treat a variety of bacterial infections. It is a broad-spectrum antibiotic that is effective against both Gram-positive and Gram-negative bacteria. Cefepime works by inhibiting the synthesis of the bacterial cell wall, ultimately leading to cell death.

Uses and Indications

Cefepime is used to treat a wide range of bacterial infections, including:

• Pneumonia ^[1]
• Urinary tract infections ^[2]
• Skin and soft tissue infections
• Intra-abdominal infections (often in combination with metronidazole) ^[3]

Dosage and Administration

Cefepime is administered intravenously or intramuscularly. The recommended dosage depends on the type and severity of the infection, as well as the patient’s age and renal function. In general, the usual adult dose ranges from 1 to 2 grams every 8 to 12 hours. Dosage adjustments may be necessary for patients with impaired renal function.

Side Effects and Adverse Reactions

Common side effects of cefepime include:

• Diarrhea
• Nausea and vomiting
• Rash
• Headache
• Injection site reactions (pain, inflammation)

Severe side effects are rare but may include anaphylaxis, seizures, and Clostridium difficile-associated diarrhea.

Drug Interactions

Cefepime may interact with other medications, including:

• Aminoglycoside antibiotics (increased risk of nephrotoxicity)
• Loop diuretics (increased risk of nephrotoxicity)
• Probenecid (may increase cefepime levels)

Mechanism of Action

Cefepime, like other cephalosporins, inhibits bacterial cell wall synthesis by binding to and inactivating penicillin-binding proteins (PBPs). This disrupts the cross-linking of peptidoglycan, a critical component of the bacterial cell wall, leading to cell lysis and death.

Mechanism of Drug Resistance

Bacterial resistance to cefepime can occur through several mechanisms, including:

• Production of beta-lactamases that inactivate the drug
• Alterations in PBPs that reduce their affinity for cefepime
• Changes in bacterial cell wall permeability that limit drug uptake
• Efflux pumps that actively remove cefepime from the cell

Contraindications and Precautions

Cefepime is contraindicated in patients with a known hypersensitivity to cefepime or other cephalosporins. It should be used with caution in patients with a history of penicillin allergy, as cross-reactivity may occur. Dosage adjustments are necessary for patients with renal impairment. Prolonged use may result in the overgrowth of nonsusceptible organisms, including fungi.