Cefepime
Детермінований перегляд YAML-сутності з джерельної бази. Клінічний авторитет лишається за вказаними source ID та статусом клінічного sign-off.
| ID | DRUG-CEFEPIME |
|---|---|
| Тип | Препарат |
| Синоніми | MaxcefMaxipimeЦефепім |
| Статус | переглянуто 2026-04-27 | очікує клінічного підпису |
| Хвороби | Не вказано |
| Джерела | SRC-NCCN-BCELL-2025 SRC-NCCN-MM-2025 |
Дані про препарат
| Клас | Fourth-generation cephalosporin (extended Gram-negative + Gram-positive coverage; AmpC stable) |
|---|---|
| Механізм дії | 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). |
| Типове дозування | 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. |
| Зареєстровано в Україні | True |
| Відшкодовується НСЗУ | True |
| Остання перевірка для України | 2026-04-27 |
Нотатки
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.
Де використовується
У YAML-корпусі не знайдено зворотних посилань.