Cefepim, 1 g

A fourth generation cephalosporin antibiotic for parenteral use.

It has a bactericidal effect by disrupting the synthesis of the cell wall of microorganisms.

It is active against most gram-negative bacteria including those producing β-lactamases including Pseudomonas aeruginosa.

It is more active than III generation cephalosporins against Gram-positive cocci.

It is not active against Enterococcus spp., Listeria spp., Legionella spp., some anaerobic bacteria (Bacteroides fragilis, Clostridium difficile).

Cefepim is characterized by high stability against various plasmid and chromosomal β-lactamases.

Indications

Diseases caused by microorganisms sensitive to Cefipime:

Active ingredient

Composition

Active substance:

cefepime hydrochloride (in terms of cefepime) -1.0 g.

How to take, the dosage

The antibiotic is injected deep into the buttock or into a vein. The latter is preferred in life-threatening cases. For this method of administration the drug is diluted with water for injection, physiological solution or glucose (5-10 ml). The drug is administered by drip or by intravenous injection, slowly (up to 5 minutes).

Injection into the muscle, the powder is dissolved with water for injection, physiological solution, dextrose, lidocaine hydrochloride solution (1-0.5%). The required amount of solvent is 2.4 ml.

In adults Cefepim is prescribed in a dose of 1 g every 12 hours for seven days (sometimes the treatment is extended to 10 days). In life-threatening conditions the dosage, number of doses per day, and duration of treatment may be adjusted by the physician.

The type of injection may be chosen depending on the severity of the infection and the degree of renal impairment.

This antibiotic is practiced as a preventive measure in surgical interventions.

In children from 2 months of age it is prescribed 50 mg per 1 kg of body weight of the child every 12 hours. For children from one month of age it may be prescribed at a dose of 30 mg per 1 kg of body weight.

In severe cases, the dosage, the number of doses per day and the duration of treatment can be adjusted by the doctor. The standard duration of treatment is 7 to 10 days.

Interaction

Cefepime solution should not be mixed with solutions of metronidazole, vancomycin, gentamicin, tobramycin, netilmicin, aminophylline. If necessary, these solutions are administered separately.

The drug solution may be added to the ampicillin solution if the concentration of each of the mixing solutions does not exceed 40 mg/ml.

Diuretics, aminoglycosides and polymyxin B reduce tubular secretion of cefepime, prolong the elimination half-life, increase the drug concentration in blood; increases nephrotoxicity.

Non-steriodic anti-inflammatory drugs slow the excretion of cephalosporins and increase the risk of bleeding.

When used simultaneously with aminoglycosides it shows synergism, with macrolides, chloramphenicol or tetracyclines – antagonism.

Special Instructions

If an aerobic-anaerobic infection is suspected, additional administration of an antibacterial agent active against anaerobic microorganisms is recommended before the pathogen is identified; the drugs should be administered separately!
Patients with possible dissemination from the focus of infection and suspected meningitis should be given an alternative antibiotic with clinically proven efficacy for meningitis.

If pseudomembranous colitis develops, the drug should be withdrawn; moderate to severe complications require vancomycin or metronidazole.

Possible cross-sensitivity in patients with allergic reactions to penicillins. If an allergic reaction occurs, the drug is discontinued; a serious immediate reaction may require epinephrine, glucocorticoid and other emergency measures.

In severe renal/hepatic impairment, the blood concentration of the drug should be monitored regularly.

In case of treatment duration of more than 10 days, regular monitoring of blood parameters and functional status of the liver and kidneys is necessary.

Contraindications

In the presence of allergies to cephalosporins, penicillin, beta-lactam antibiotics, el-arginine.

The drug has not been tested correctly in pregnant and breastfeeding women; this group of patients uses treatment with this antibiotic only under the direct supervision of a physician.

Side effects

Cefipime has good tolerability.

Rarely: hepatitis, jaundice, colitis, bloating, nausea, allergic reaction, tachycardia, insomnia, dizziness, shortness of breath.

In intravenous administration, there is very rarely inflammation of vascular tissue.

Overdose

It occurs more often in patients with chronic renal insufficiency.

Symptoms: seizures, encephalopathy, neuromuscular agitation.

Treatment: in renal failure, hemodialysis; close monitoring and supportive therapy with normal renal function.