Cefepime
Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.
| ID | DRUG-CEFEPIME |
|---|---|
| Type | Drug |
| Aliases | MaxcefMaxipimeЦефепім |
| Status | reviewed 2026-04-27 | pending_clinical_signoff |
| Diseases | None declared |
| Sources | SRC-NCCN-BCELL-2025 SRC-NCCN-MM-2025 |
Drug Facts
| Class | Fourth-generation cephalosporin (extended Gram-negative + Gram-positive coverage; AmpC stable) |
|---|---|
| Mechanism | Zwitterionic fourth-generation cephalosporin that rapidly penetrates the outer membrane of Gram-negative bacteria via porin channels and binds penicillin-binding proteins (PBP-3 primarily), inhibiting bacterial cell-wall synthesis with bactericidal effect. Stable against AmpC β-lactamases (chromosomal, common in Enterobacter, Citrobacter, Serratia, Proteus indole-positive — "ESCAPPM" / SPACE organisms) and most Gram-positive PBP-2a, but hydrolyzed by ESBLs and KPC carbapenemases. Excellent activity vs Pseudomonas aeruginosa, Enterobacterales, methicillin-susceptible staphylococci, streptococci. Limited anaerobic coverage (no Bacteroides fragilis activity). FDA-approved 1996; widely used as monotherapy for febrile neutropenia (alternative to pip-tazo). |
| Typical dosing | Febrile neutropenia (adult): 2 g IV every 8 hours via 30-min infusion (preferred over q12h for FN given the bactericidal time-above-MIC PK/PD). Pediatric: 50 mg/kg IV q8h, max 2 g. Renal adjustment required: CrCl 30-60 → 2 g q12h; CrCl 11-29 → 2 g q24h; CrCl <11 → 1 g q24h; hemodialysis → 1 g q24h with dose after dialysis on dialysis days; CRRT → 2 g q12h (per institutional protocol). Hepatic: no adjustment. Duration in FN: until ANC recovery (>500/µL) and afebrile ≥48 h. CRITICAL: cefepime neurotoxicity (encephalopathy, myoclonus, non-convulsive status epilepticus) is a recognized concern, especially with renal dysfunction and elderly — mandates meticulous renal dosing. |
| Ukraine registered | True |
| NSZU reimbursed | True |
| Ukraine last verified | 2026-04-27 |
Notes
Alternative first-line FN empirical agent to piperacillin/tazobactam, with key advantage of avoiding the pip-tazo + vancomycin AKI signal and lacking the high sodium load. Disadvantage: limited anaerobic coverage (add metronidazole if intra-abdominal source suspected), and the recognized cefepime neurotoxicity hazard in renal dysfunction. Cefepime-induced encephalopathy: confusion → myoclonus → non- convulsive status epilepticus, often misattributed to sepsis or underlying disease; key clue is recent renal function decline + dose not adjusted; EEG shows generalized periodic discharges; treatment is discontinuation ± hemodialysis. ECIL-4 and IDSA 2010 list cefepime as preferred FN monotherapy alongside pip-tazo and meropenem. Avoid in patients with documented cefepime neurotoxicity or in elderly with eGFR <30 unless reduced dose meticulously applied. Ukraine: widely available, NSZU-covered.
Used By
No reverse references found in the YAML corpus.