cefepime dihydrochloride monohydrate: clinical use

Prescribing considerations

• Confirm that the likely or identified pathogen is susceptible; cefepime does not adequately cover every cause of serious infection.
• Review renal function before and during treatment, particularly in older people or when renal function may change.
• Assess beta-lactam allergy history carefully before administration.
• Consider antibiotic-associated colitis if significant diarrhoea develops during or after treatment.
• Be aware of false-positive copper-reduction urine-glucose tests and positive direct Coombs tests without haemolysis.

Contraindications and cautions

• Hypersensitivity to cefepime, another cephalosporin or an excipient
• Previous severe hypersensitivity reaction to another beta-lactam antibacterial, including penicillins, monobactams or carbapenems

Monitoring

• Renal function and signs of cefepime accumulation
• Mental state, myoclonus or seizure activity, especially with renal impairment
• Clinical response, microbiology and emergence of superinfection or resistance
• Blood count, liver tests and coagulation where clinically indicated
• Gastrointestinal symptoms suggesting antibiotic-associated colitis

Clinical pharmacology

Cefepime is a bactericidal fourth-generation cephalosporin. It has low protein binding, is eliminated mainly unchanged by glomerular filtration and has time-dependent antibacterial activity.

Formulation and product differences

• The selected product is a white to pale-yellow powder containing cefepime with L-arginine.
• After reconstitution it may be administered intravenously or intramuscularly; the selected vial is intended for single use.
• Diluent compatibility, intravenous-route incompatibilities and storage after preparation depend on how the solution is reconstituted.

Injection

Route: Parenteral

Strengths: 1 g, 2 g