Pharmacology

Cefepime is a broad-spectrum, β-lactam antibiotic belonging to the fourth-generation cephalosporins. It inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs), resulting in cell lysis. It is stable against most β-lactamases, including extended-spectrum β-lactamases (ESBLs), and has enhanced activity against both Gram-positive and Gram-negative organisms, including Pseudomonas aeruginosa.

Indication

Cefepime is indicated for the treatment of infections caused by susceptible bacteria, including:

  • Lower respiratory tract infections (e.g., pneumonia)

  • Urinary tract infections, both complicated and uncomplicated

  • Skin and soft tissue infections

  • Intra-abdominal infections (in combination with metronidazole)

  • Febrile neutropenia

  • Septicemia

  • Meningitis

Dosage & Administration

Adults:

  • 1–2 g IV/IM every 8–12 hours depending on severity and type of infection.

  • Febrile neutropenia, nosocomial pneumonia, severe infections: 2 g IV every 8 hours.

Children (2 months to 16 years):

  • 50 mg/kg every 8–12 hours (max: 2 g/dose).

Renal impairment: Dose adjustment is necessary.

Route: IV (preferred for severe infections), IM (for mild to moderate infections).

Drug Interactions

  • Aminoglycosides: Increased risk of nephrotoxicity.

  • Loop diuretics: May enhance nephrotoxic effects.

  • Live vaccines (e.g., Typhoid): Antibacterial activity may reduce vaccine efficacy.

Contraindications

  • Hypersensitivity to cephalosporins or any components of the formulation.

  • History of anaphylactic reactions to β-lactam antibiotics.

Side Effects

Common:

  • Diarrhea

  • Nausea

  • Rash

  • Injection site reactions

Serious:

  • Anaphylaxis

  • Seizures (especially in renal impairment)

  • Clostridioides difficile-associated diarrhea

  • Neutropenia/thrombocytopenia

Pregnancy & Lactation

Pregnancy: Category B
Animal studies have not shown harm, but use only if clearly needed in humans.

Lactation:
Cefepime is excreted in breast milk in low concentrations. Use with caution during breastfeeding.

Precautions & Warnings

  • Monitor renal function, especially in the elderly and those with pre-existing kidney issues.

  • Risk of neurotoxicity (e.g., encephalopathy, seizures) in renal impairment.

  • Caution in patients with a history of gastrointestinal disease, especially colitis.

  • Periodic blood counts should be monitored during prolonged therapy.

Overdose Effects

  • May cause neurotoxicity, including seizures, encephalopathy, confusion.

  • Hemodialysis can help remove cefepime in overdose cases.

Therapeutic Class

  • Fourth-generation cephalosporins

Storage Conditions

  • Store the dry powder at 20–25°C (68–77°F).

  • Reconstituted solution: Use immediately or store refrigerated (2–8°C) for up to 24 hours.

Chemical Structure of Cefepime Hydrochloride

Molecular Formula: C19H24ClN6O5S2
Molecular Weight: 571.02 g/mol

Here’s a simplified chemical structure (line-angle structure representation):

      O
      ||
  R – C – N – R’
       |
     β-lactam
     ring (4-membered)

More precisely:

Cefepime has:

  • A β-lactam ring

  • A dihydrothiazine ring

  • A quaternary N-methylpyrrolidine group

  • A methoxyimino group for resistance to β-lactamase

  • A zwitterionic character enhancing outer membrane penetration

 
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