Fourth generation cephalosporin

Antibacterial

Pnemonia; Empiric therapy for febrile neutropenic patients; uncomplicated skin and skin-structure infections; uncomplicated and complicated UTIs, including pyelonephritis complicated intra-abdominal infrctions

FDA Pregnancy Category B 

Breast-feeding

Other cephalosporins are distributed into breast milk, usually in low concentrations. However, problems in humans have not been documented to date.

Pediatrics

Lower metabolic and/or renal clearance of cepha­losporins, with resulting prolonged half-life, has been reported in new­born infants. Appropriate studies on the relationship of age to the effects of these cephalosporins have not been performed in the pediatric population. However, no pediatrics-specific problems have been documented to date.

Geriatrics

Cephaiosporins have been used in the geriatriC population, and no geri­atrics-specific problems have been documented to date. However, el­derly patients are more likely to have an age-related decrease in renal function, which may require an adjustment in dosage andlor dosing interval in patients receiving cephalosporins.

Dental

Long-term therapy with cephalosporins may allow for the overgrowth of Candida albicans, resulting in oral candidiasis.

Contraindications

Except under special circumstances, this medication should not be used when the following medical problem exists:

» Previous allergic reaction (anaphylaxis) to penicillins, penicillin deriv­atives, penicillamine, or cephalosporins

Risk-benefit should be considered when the following medical prob­lems exist:

» Colitis, history of or

»  Gastrointestinal disease, history of, especially ulcerative colitis, reo gional enteritis, or antibiotic-associated colitis (cephalosporins may cause pseudomembranous colitis)

» Renal function impairment

Drug interactions

Platelet aggregation inhibitors; Probenecid

intraabdominal infections, complicated-

Intravenous, 2 grams (base), in combination with metronidazole, every twelve hours for seven to ten days.

[Septicemia] or Skin and soft tissue infections, uncomplicated, moderate to severe or Urinary tract infections, severe-

Intravenous,2 grams (base) every twelve hours for ten days.

Neutropenia, febrile-

Intravenous, 2 grams (base) every eight hours for seven days or until resolution of neutropenia.

Note: In patients whose fever resolves but who remain neutropenic for more than seven days, the need for continued antimicrobial therapy should be re-evaluated frequently.

Pneumonia, moderate to severe-

Intravenous, 1 to 2 grams (base) every twelve hours for ten days.

Urinary tract infections, mild to moderate-

Intramuscular or intravenous, 500 mg to 1 gram (base) every twelve hours for seven to ten days.

Pneumonia, moderate to severe or Skin and skin structure infection, moderate to severe, uncomplicated or­ Urinary tract infection, mild or moderate, uncomplicated or complicated-

Infants and children 2 months to 16 years of age (up to 40 kg of body weight): Intravenous, 50 mg per kg of body weight every 12 hours for 10 days (7 to 10 days for urinary tract infection).

Urinary tract infection, severe, uncomplicated or complicated-

Infants and children 2 months to 16 years of age (up to 40 kg of body weight): Intravenous or intramuscular, 50 mg per kg of body weight every 12 hours for 7 to 10 days.

Note: Intramuscular route of administration is indicated only for mild to moderate, uncomplicated or complicated urinary tract infec­tions due to Escherichia coli in the event that intramuscular administration is determined to be the more appropriate drug administration route.

Febrile neutropenia, empiric therapy-

Infants and children 2 months to 16 years of age (up to 40 kg of body weight): Intravenous, 50 mg per kg of body weight every 8 hours for 7 days or until resolution of neutropenia.

Note: In patients whose fever resolves but who remain neutropenic for more than seven days, the need for continued antimicrobial therapy should be re-evaluated frequently.

Usual pediatric prescribing limits 

The maximum pediatric dose should not exceed the dose recommended for adults.

Those indicating need for medical attention

Incidence more frequent

Eosinophilia, Hypersensitivity reactions, Hypoprothrombinemia, pseudomembranous colitis, thrombophlebitis, Urticaria

Incidence rare

Allergic reactions, specifically anaphylaxis, Epidermal necrolysis, toxic, erythema multiforme or Stevens-Johnson syndrome, hearing loss, hemolytic anemia, immune, drug-induced, leukopenia, neutropenia, or thrombocytopenia, renal dysfunction, serum sickness-like reactions, seizures

Incidence unknown

Agranulocytosis, aplastic anemia,hemorrhage, Hepatic dysfunction, including cholestasis, pancytopenia, superinfection, toxic nephropathy.

Those indicating possible pseudomembranous colitis and the need for medical attention if they occur after medication is discontinued

Abdominal or stomach cramps and pain, severe; abdominal ten­derness; diarrhea, watery and severe, which mayalso be bloody; fever

Prior to reconstitution,store between 2 and 25^oC.protect from light.Tobe used immediately after reconstitution.

Boxes of 10 vials 500,1000 &2000 mg cefepime hydrochloride,injection,powder for solution

Cefepime should not be added to ampicillin solutions of a strength greater than 40 mg per mL,or to aminophylline, gentamicin, metronidazole, netilmicin, tobramycin, or vancomycin solutions. If these medications are administered concurrently with cefepime, they should be admin­istered at separate sites .