Cefepime: Drug information

For additional information see "Cefepime: Patient drug information" and "Cefepime: Pediatric drug information"

For abbreviations, symbols, and age group definitions show table

Brand Names: Canada

APO-Cefepime

Pharmacologic Category

Antibiotic, Cephalosporin (Fourth Generation)

Dosing: Adult

Dosage guidance:

Dosing: Dosing is presented based on the traditional intermittent infusion method over 30 minutes, unless otherwise specified as the extended-infusion method over 3 to 4 hours or continuous infusion method over 24 hours (off-label methods).

Usual dosage range:

Traditional intermittent infusion method (over 30 minutes): IV: 1 to 2 g every 8 to 12 hours. For coverage of serious Pseudomonas aeruginosa infections: 2 g every 8 hours (Ref). For infections caused by an organism with a minimum inhibitory concentration (MIC) <4 mg/L, 1 g every 6 hours achieves pharmacodynamic parameters comparable to 2 g every 8 hours; reserve for use in less serious infections (Ref).

Extended infusion method (off-label method): IV: 2 g every 8 hours infused over 3 or 4 hours (Ref); may give first dose over 30 minutes (Ref). The extended infusion method is preferred for treatment of infections caused by AmpC beta-lactamase-producing Enterobacterales (eg, Enterobacter cloacae, Klebsiella aerogenes, Citrobacter freundii); however, cefepime should only be used for these infections when the MIC is ≤2 mcg/mL (Ref).

Continuous infusion method (off-label method): IV: 4 to 6 g infused over 24 hours (Ref); may give first dose of 2 g over 30 minutes, especially when rapid attainment of therapeutic drug concentrations (eg, sepsis) is desired (Ref).

Bloodstream infection

Bloodstream infection (gram-negative bacteremia) (off-label use):

Community-acquired infection, without sepsis or septic shock (immunocompetent host and no infections with P. aeruginosa in prior 3 to 6 months): IV: 2 g every 12 hours (Ref).

Health care–associated infection (including catheter-related infection, infection in immunocompromised hosts, patients with sepsis or septic shock, or for coverage of P. aeruginosa): IV: 2 g every 8 hours (Ref). Note: For empiric therapy of gram-negative bloodstream infection in patients with sepsis or septic shock and for empiric therapy of P. aeruginosa bloodstream infection in patients with neutropenia or severe burns, some experts recommend giving cefepime with a second gram-negative active agent (Ref). Some experts also prefer extended or continuous infusion for critical illness or when treating a susceptible organism with an elevated MIC (Ref).

Duration of therapy: Usual duration is 7 to 14 days; individualize duration depending on source and extent of infection as well as clinical response. A 7-day duration is recommended for patients with uncomplicated Enterobacteriaceae infection who respond appropriately to antibiotic therapy (Ref). If neutropenic, extend treatment until afebrile for ≥48 hours and recovery of neutrophils (ANC ≥500 cells/mm³ and increasing) (Ref). For P. aeruginosa bacteremia in patients who are neutropenic, some experts treat for a minimum of 14 days and until recovery of neutrophils (Ref).

Cystic fibrosis, acute pulmonary exacerbation

Cystic fibrosis, acute pulmonary exacerbation (off-label use): For empiric or targeted therapy of P. aeruginosa or other gram-negative bacilli:

IV: 2 g every 8 hours, usually given as part of an appropriate combination regimen (Ref). Note: Some experts prefer the extended or continuous infusion method to optimize exposure (Ref).

Duration of therapy: Duration is usually 10 to 14 days depending on clinical response (Ref).

Diabetic foot infection, moderate to severe

Diabetic foot infection, moderate to severe (off-label use): IV: 2 g every 8 to 12 hours in combination with other appropriate agents (Ref).

Duration of therapy: Duration (which may include oral step-down therapy) is usually 2 to 4 weeks in the absence of osteomyelitis (Ref).

Intra-abdominal infection, health care–associated or high-risk community-acquired infection

Intra-abdominal infection, health care–associated or high-risk community-acquired infection:

Note: For community-acquired infection, reserve for severe infection or patients at high risk of adverse outcome and/or resistance (Ref):

Cholecystitis, acute: IV: 2 g every 8 to 12 hours; if P. aeruginosa is suspected, use 2 g every 8 hours. Continue for 1 day after gallbladder removal or until clinical resolution in patients managed nonoperatively (Ref).

Other intra-abdominal infections (eg, cholangitis, appendicitis, diverticulitis, intra-abdominal abscess): IV: 2 g every 8 to 12 hours in combination with metronidazole, and, when appropriate, other agents; if P. aeruginosa is suspected, use 2 g every 8 hours. Total duration of therapy (which may include transition to oral antibiotics) is 4 to 5 days following adequate source control (Ref). For diverticulitis or uncomplicated appendicitis managed without intervention, duration is 10 to 14 days (Ref); for perforated appendicitis managed with laparoscopic appendectomy, 2 to 4 days may be sufficient (Ref). Note: For patients who are critically ill or are at high risk for infection with drug-resistant pathogens, some experts favor the extended or continuous infusion method (Ref).

Intracranial abscess and spinal epidural abscess

Intracranial abscess (brain abscess, intracranial epidural abscess) and spinal epidural abscess (off-label use): As a component of empiric therapy in patients at risk for P. aeruginosa or another resistant gram-negative bacteria (eg, neurosurgical or immunocompromised patients):

IV: 2 g every 8 hours as part of an appropriate combination regimen; duration generally ranges from 4 to 8 weeks for brain abscess and spinal epidural abscess and 6 to 8 weeks for intracranial epidural abscess (Ref).

Meningitis, bacterial

Meningitis, bacterial (off-label use): Note: As a component of empiric therapy for health care–associated infections or infections in immunocompromised patients, or as pathogen-specific therapy (eg, gram-negative bacteria, including P. aeruginosa):

IV: 2 g every 8 hours; for empiric therapy, use in combination with other appropriate agents (Ref). Treatment duration for gram-negative bacilli is a minimum of 10 to 14 days, although some experts recommend ≥21 days (Ref).

Neutropenic enterocolitis

Neutropenic enterocolitis (typhlitis) (off-label use): IV: 2 g every 8 hours in combination with metronidazole (Ref). In patients who have clinical resolution following neutropenia and who did not have signs of severe disease at the time of diagnosis, the duration of antibiotics is 14 days following recovery from neutropenia; many patients can be switched to an appropriate oral antibiotic regimen once neutropenia has resolved (Ref).

Neutropenic fever, high-risk cancer patients

Neutropenic fever, high-risk cancer patients (empiric therapy): Note: High-risk patients are those expected to have an ANC ≤100 cells/mm³ for >7 days or an ANC ≤100 cells/mm³ for any expected duration if there are ongoing comorbidities (eg, sepsis, mucositis, significant liver or renal dysfunction) (Ref); some experts use an ANC cutoff of <500 cells/mm³ to define high-risk patients (Ref).

IV: 2 g every 8 hours until afebrile for ≥48 hours and resolution of neutropenia (ANC ≥500 cells/mm³ and increasing) or standard duration for the specific infection identified, if longer than the duration of neutropenia. Additional agent(s) may be needed depending on clinical status (Ref). Some experts prefer extended or continuous infusions for critical illness (Ref).

Osteomyelitis and/or discitis

Osteomyelitis and/or discitis (off-label use): IV: 2 g every 8 to 12 hours for ≥6 weeks (Ref). For empiric therapy, use in combination with other appropriate agents (Ref).

Peritonitis, treatment

Peritonitis, treatment (peritoneal dialysis) (off-label route):

Note: Intraperitoneal administration is preferred to IV administration unless the patient has sepsis. Consider 25% dose increase in patients with significant residual kidney function (urine output >100 mL/day) (Ref).

Intermittent: Intraperitoneal: 1 g added to the dialysate solution once daily; allow to dwell ≥6 hours (Ref).

Continuous (with every CAPD exchange): Intraperitoneal: Loading dose: 500 mg/L of dialysate added to first dialysate exchange; maintenance dose: 125 mg/L of dialysate with each subsequent dialysate exchange (Ref).

Duration: For patients with adequate response, duration of therapy is ≥3 weeks. For patients with no improvement after 5 days, remove catheter and treat with appropriate systemic antibiotics for 14 days after catheter removal (Ref).

Pneumonia

Pneumonia:

Community-acquired pneumonia:For empiric therapy of inpatients at risk of infection with a resistant gram-negative pathogen(s), including P. aeruginosa:

IV: 2 g every 8 hours as part of an appropriate combination regimen. Total duration (which may include oral step-down therapy) is a minimum of 5 days; a longer course may be required for patients with an immunocompromising condition, severe or complicated infection, or for P. aeruginosa infection. Patients should be clinically stable with normal vital signs prior to discontinuation (Ref).

Hospital-acquired pneumonia or ventilator-associated pneumonia:For empiric therapy (often as part of an appropriate combination regimen) or pathogen-specific therapy of resistant gram-negative pathogen(s), including P. aeruginosa:

IV: 2 g every 8 hours. Duration of therapy varies based on disease severity and response to therapy; treatment is typically given for 7 days (Ref). Note: Some experts prefer extended or continuous infusions for critical illness or when treating a susceptible organism with an elevated MIC (Ref).

Prosthetic joint infection, pathogen-specific therapy for gram-negative bacilli

Prosthetic joint infection, pathogen-specific therapy for gram-negative bacilli (off-label use): IV: 2 g every 8 to 12 hours; duration varies but is generally 4 to 6 weeks for patients who undergo resection arthroplasty (Ref).

Sepsis and septic shock

Sepsis and septic shock (broad-spectrum empiric coverage, including P. aeruginosa) (off-label use): IV: 2 g every 8 hours (Alves 2014); use in combination with other appropriate agents when applicable. Initiate therapy as soon as possible and preferably within 1 hour of recognition of sepsis or septic shock. Duration is dependent on underlying source and patient response; short courses are preferred, when appropriate. Consider discontinuation if a noninfectious etiology is identified (Ref). Some experts prefer extended or continuous infusions (Ref).

Septic arthritis

Septic arthritis (off-label use): As a component of empiric therapy or pathogen-specific therapy for gram-negative pathogens (including P. aeruginosa): IV: 2 g every 8 to 12 hours; for empiric therapy, use in combination with other appropriate agents. Total treatment duration is 3 to 4 weeks (in the absence of osteomyelitis), including oral step-down therapy (Ref).

Skin and soft tissue infection, moderate to severe

Skin and soft tissue infection, moderate to severe:

Note: For empiric or pathogen-directed therapy in patients with or at risk for gram-negative bacteria resistant to other antibiotics (eg, P. aeruginosa) (Ref).

IV: 2 g every 8 to 12 hours; often used as part of an appropriate combination regimen. Usual duration (including oral step-down therapy) is 5 to 14 days based on severity and clinical response (Ref).

Urinary tract infection, complicated

Urinary tract infection, complicated (pyelonephritis or urinary tract infection with systemic signs/symptoms): IV: 1 to 2 g every 12 hours (Ref). For treatment of certain resistant gram-negative infections (ie, infection caused by AmpC beta-lactamase producing organisms with a cefepime MIC <4 mcg/mL), some experts recommend 2 g every 8 hours (Ref). Switch to an appropriate oral regimen once symptoms improve if culture and susceptibility results allow. Total duration of therapy ranges from 5 to 14 days; for patients with symptomatic improvement within the first 48 to 72 hours of therapy, some experts recommend shorter courses of 5 to 10 days (or 7 to 10 days if therapy is completed with cefepime) (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.

Altered kidney function: IV:

**Cefepime Dosage Adjustments in Altered Kidney Function^a**
CrCl^b	If the usual recommended dose is 1 g every 12 hours	If the usual recommended dose is 2 g every 12 hours	If the usual recommended dose is 1 g every 6 hours	If the usual recommended dose is 2 g every 8 hours
^aKuti 2010; Lodise 2006; Tam 2003; manufacturer's labeling.
^bCrCl can be calculated using the Cockcroft-Gault equation (Jonckheere 2016).
^cLodise 2006.
^d1 g every 12 hours increases the likelihood of pharmacodynamic target attainment and is preferred for serious infections or organisms with less susceptible MICs (Kuti 2010; Tam 2003). Administer a 2 g loading dose when rapid attainment of therapeutic concentrations is desired (expert opinion).
>60 mL/minute	No dosage adjustment necessary	No dosage adjustment necessary	No dosage adjustment necessary	No dosage adjustment necessary
30 to 60 mL/minute	1 g every 24 hours	1 g every 12 hours	CrCl 50 to 60 mL/minute: No dosage adjustment necessary. CrCl 30 to 49 mL/minute: 1 g every 8 hours.^c	2 g every 12 hours
11 to 29 mL/minute	500 mg every 24 hours	1 g every 24 hours	1 g every 12 hours	1 g every 12 hours^d or 2 g every 24 hours
<11 mL/minute	250 mg every 24 hours	500 mg every 24 hours	1 g every 24 hours	1 g every 24 hours

Augmented renal clearance (measured urinary CrCl ≥130 mL/minute/1.73 m²): Augmented renal clearance (ARC) is a condition that occurs in certain critically-ill patients without significant organ dysfunction. Younger patients (<55 years of age) admitted post trauma or major surgery are at highest risk for ARC, as well as those with sepsis, burns, or hematological malignancies. A measured urinary clearance is necessary to identify these patients.

Note: Limited data available; dosing based on Monte Carlo simulation and expert opinion.

IV: Initial: 2 g every 6 hours infused over 3 hours when used empirically or in patients with known minimum inhibitory concentrations (MICs) >4 mg/L (Ref). Closely monitor patient for response and adverse reactions (eg, neurotoxicity) due to drug accumulation. Consider obtaining drug concentrations when available.

Hemodialysis, intermittent (thrice weekly): Note: Achievement of cefepime pharmacodynamic targets is dependent on organism MIC, the absence or presence of residual kidney function, and interval between dialysis sessions (ie, 2- or 3-day interdialytic interval) (Ref). Factors such as severity of illness, location of infection, and patient weight should be considered when selecting between the higher and lower dosing regimens as well.

IV: Dialyzable (70% to 85% reduction in serum concentration from a 3.5- to 4-hour hemodialysis treatment with high flux filters (Ref)).

Daily dosing (administer after hemodialysis on dialysis days): IV: Initial: 1 g (single dose) on day 1. Maintenance: 500 mg to 1 g every 24 hours (Ref). Note: If the usual recommended dose for normal renal function is 2 g every 8 hours or 1 g every 6 hours, utilize 1 g every 24 hours; use 500 mg every 24 hours for all other doses (Ref).

**Thrice-Weekly (Postdialysis) Cefepime Dosing^a**
Residual kidney function and organism susceptibility	Cefepime dose for a 2-day interdialytic interval (ie, next dialysis expected in 48 hours)	Cefepime dose for a 3-day interdialytic interval (ie, next dialysis expected in 72 hours)
^aExpert opinion derived from Descombes 2016; Perez 2012; Schmaldienst 2000.
Patient is anuric AND the organism MIC <4 mg/L	1.5 g after hemodialysis	2 g after hemodialysis
Any of the following: Empiric therapy OR Patient has residual kidney function OR Organism MIC ≥4 mg/L	2 g after hemodialysis	2 g after hemodialysis

Peritoneal dialysis:

IV: 1 g every 24 hours (Ref).

CRRT: Drug clearance is dependent on the effluent flow rate, filter type, and method of renal replacement. Recommendations are based on high-flux dialyzers and effluent flow rates of 20 to 25 mL/kg/hour (or approximately 1,500 to 3,000 mL/hour) unless otherwise noted. Appropriate dosing requires consideration of adequate drug concentrations (eg, site of infection), organism MIC, residual kidney function, and consideration of initial loading doses. Close monitoring of response and adverse reactions (eg, neurotoxicity) due to drug accumulation is important.

CVVH/CVVHD/CVVHDF: IV: 2 g every 8 to 12 hours (Ref).

Note: For severe infections or sepsis, the risks/benefits favor dosing on the higher side of the recommended frequency (Ref). For CRRT with other effluent rates: If effluent rate is <20 mL/kg/hour, 2 g every 12 hours is preferred (Ref). If effluent rate is ≥35 mL/kg/hour, 2 g every 8 hours is preferred (Ref).

PIRRT (eg, sustained, low-efficiency diafiltration): Drug clearance is dependent on the effluent flow rate, filter type, and method of renal replacement. Appropriate dosing requires consideration of adequate drug concentrations (eg, site of infection), organism MIC, residual kidney function, and consideration of initial loading doses. Close monitoring of response and adverse reactions (eg, neurotoxicity) due to drug accumulation is important.

Note: Regimens developed through Monte Carlo simulation only and based on daily treatments with 4 to 5 L/hour of dialysate/ultrafiltrate flow rate for each 8- to 10-hour session (Ref).

Option 1: IV: 2 g loading dose, followed by 1 g every 6 hours regardless of when prolonged intermittent renal replacement therapy (PIRRT) treatments occur relative to cefepime infusions (Ref).

Option 2 (if every 6 hours not desired [eg, patient self-administering]): IV: 2 g at beginning of PIRRT session, then 3 g after PIRRT session ends. Repeat regimen with every PIRRT session (Ref).

Non-PIRRT days: IV: Select dose based on assessment of nondialysis kidney function (eg, CrCl <11, then 1 g every 24 hours).

Dosing: Hepatic Impairment: Adult

The liver dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Matt Harris, PharmD, MHS, BCPS, FAST; Jeong Park, PharmD, MS, BCTXP, FCCP, FAST; Arun Jesudian, MD; Sasan Sakiani, MD.

Liver impairment prior to treatment initiation:

Child-Turcotte-Pugh class A to C: No dosage adjustment necessary (Ref).

Dosing: Obesity: Adult

The recommendations for dosing in patients with obesity are based upon the best available evidence and clinical expertise. Senior Editorial Team: Jeffrey F. Barletta, PharmD, FCCM; Manjunath P. Pai, PharmD, FCP; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC.

Class 1, 2, or 3 obesity (BMI ≥30 kg/m²): Note: Use of traditional (intermittent) dosing in patients who are obese is generally appropriate.

Traditional intermittent infusion method: IV: 2 g every 8 hours infused over 30 minutes (Ref).

Extended-infusion method: Note: Preferred for patients with BMI >40 kg/m², for life-threatening infections caused by resistant pathogens (eg, minimum inhibitory concentrations approaching 8 mg/L), with infection-site penetration limitations, or for critically ill patients with augmented renal function (Ref).

IV: 2 g every 8 hours infused over 3 to 4 hours. Note: May give a loading dose of 2 g over 30 minutes when rapid attainment of therapeutic drug concentrations is necessary (eg, sepsis) (Ref).

Rationale for recommendations:

There are limited data evaluating the effect of obesity on dosing requirements for cefepime. Currently, data are available from noncritically and critically ill, hospitalized patients. Lower trough concentrations and increased V_d estimates are reported in patients who are obese compared with patients who are not obese (Ref).

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Cefepime: Pediatric drug information")

General dosing, susceptible infection:

Traditional intermittent-infusion method: Infants, Children, and Adolescents:

Non-Pseudomonas spp. infections: IM, IV: 50 mg/kg/dose every 12 hours; maximum dose: 2,000 mg/dose (Ref). Note: Every-12-hour dosing may be suboptimal for infections caused by bacteria with minimum inhibitory concentrations (MICs) ≥1 mg/L based on pharmacokinetic modeling (Ref).

Pseudomonas spp. infections (suspected or proven): IM, IV: 50 mg/kg/dose every 8 hours; maximum dose: 2,000 mg/dose (Ref).

Extended-infusion method: Limited data available: Infants, Children, and Adolescents: IV: 50 mg/kg/dose infused over 3 to 4 hours every 8 hours; maximum dose: 2,000 mg/dose; dosing based on a pharmacokinetic modeling study, a case series, and a retrospective comparative study (Ref). Note: Extended-infusion dosing may be preferred for susceptible dose-dependent pathogens (MIC of 4 or 8 mg/L) (Ref).

Cystic fibrosis, acute pulmonary exacerbation

Cystic fibrosis, acute pulmonary exacerbation: Infants, Children, and Adolescents: IV: 50 mg/kg/dose every 8 hours; maximum dose: 2,000 mg/dose; patients with more resistant pseudomonal isolates (MIC ≥16 mg/L) may require 50 mg/kg/dose every 6 hours (Ref). Note: Some experts prefer extended or continuous infusion methods to optimize antipseudomonal beta-lactam exposure in patients with cystic fibrosis (Ref).

Endocarditis, prosthetic valve, treatment within 1 year of replacement

Endocarditis, prosthetic valve, treatment within 1 year of replacement: Children and Adolescents: IV: 50 mg/kg/dose every 8 to 12 hours in combination with vancomycin and rifampin for 6 weeks plus gentamicin for the first 2 weeks; maximum dose: 2,000 mg/dose (Ref).

Febrile neutropenia, empiric therapy

Febrile neutropenia, empiric therapy: Infants, Children, and Adolescents: IV: 50 mg/kg/dose every 8 hours; maximum dose: 2,000 mg/dose (Ref); duration of therapy dependent upon febrile neutropenia risk-status; in high-risk patients, may discontinue empiric antibiotics if all of the following criteria met: Negative blood cultures at 48 hours; afebrile for at least 24 hours, and evidence of marrow recovery. In low-risk patients, may discontinue empiric antibiotics after 72 hours duration in patients with a negative blood culture and who have been afebrile for 24 hours regardless of marrow recovery status; follow-up closely (Ref).

Intra-abdominal infection, complicated

Intra-abdominal infection, complicated: Infants, Children, and Adolescents: IV: 50 mg/kg/dose every 12 hours in combination with metronidazole; maximum dose: 2,000 mg/dose. Note: IDSA guidelines recommend duration of 4 to 7 days (provided source controlled) (Ref).

Meningitis, including health care-associated ventriculitis/meningitis

Meningitis, including health care-associated ventriculitis/meningitis: Infants, Children, and Adolescents: IV: 50 mg/kg/dose every 8 hours; maximum dose: 2,000 mg/dose. Duration should be individualized based on patient characteristics and response; treatment duration for gram-negative bacilli is a minimum of 10 to 14 days, although some experts recommend ≥21 days and at least 14 days after first negative cerebrospinal fluid culture (Ref).

Peritonitis

Peritonitis (peritoneal dialysis) (Ref): Infants, Children, and Adolescents: Intraperitoneal:

Intermittent: 15 mg/kg/dose every 24 hours into the long dwell.

Continuous: Loading dose: 500 mg per liter of dialysate; maintenance dose: 125 mg per liter.

Pneumonia, moderate to severe

Pneumonia, moderate to severe: Infants ≥2 months, Children, and Adolescents:

Due to P. aeruginosa: IV: 50 mg/kg/dose every 8 hours for 10 days; maximum dose: 2,000 mg/dose.

Not due to P. aeruginosa: IV: 50 mg/kg/dose every 12 hours for 10 days; maximum dose: 2,000 mg/dose.

Skin and skin structure infection, uncomplicated

Skin and skin structure infection, uncomplicated: Infants ≥2 months, Children, and Adolescents: IV: 50 mg/kg/dose every 12 hours for 10 days; maximum dose: 2,000 mg/dose.

Urinary tract infection, complicated and uncomplicated

Urinary tract infection, complicated and uncomplicated: Infants ≥2 months, Children, and Adolescents:

Mild to moderate infection: IM, IV: 50 mg/kg/dose every 12 hours for 7 to 10 days; maximum dose: 1,000 mg/dose. Note: IM may only be considered for mild to moderate infections due to E. coli.

Severe infection: IV: 50 mg/kg/dose every 12 hours for 10 days; maximum dose: 2,000 mg/dose.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

Note: Dosing is based on pharmacokinetic parameters, limited pediatric studies, adult studies, manufacturer labeling, and expert opinion.

Altered kidney function:

Infants, Children, and Adolescents: IV, IM:

**Cefepime Dosing Adjustments for Maintenance Dose in Renal Impairment**
CrCl	Recommended Dosing Schedule
Note: Dosing regimens reflect the similarity in cefepime pharmacokinetics between adult and pediatric patients and are generally proportional to the changes made in adult patients. Based on minimum inhibitory concentrations (MIC) of bacteria, higher doses may be indicated (Shoji 2016). ^a Choose usual recommended dose based on indication and disease severity (see "Dosing: Pediatric"), then choose the adjusted dose from that column corresponding to the patient's CrCl.
>60 mL/minute/1.73 m² (Usual recommended dose)^a	50 mg/kg/dose every 12 hours; maximum dose: 1,000 mg/dose	50 mg/kg/dose every 12 hours; maximum dose: 2,000 mg/dose	50 mg/kg/dose every 8 hours; maximum dose: 2,000 mg/dose
30 to 60 mL/minute/1.73 m²	50 mg/kg/dose every 24 hours; maximum dose: 1,000 mg/dose	50 mg/kg/dose every 24 hours; maximum dose: 2,000 mg/dose	50 mg/kg/dose every 12 hours; maximum dose: 2,000 mg/dose
11 to 29 mL/minute/1.73 m²	25 mg/kg/dose every 24 hours; maximum dose: 500 mg/dose	25 to 50 mg/kg/dose every 24 hours; maximum dose: 1,000 mg/dose	50 mg/kg/dose every 24 hours; maximum dose: 2,000 mg/dose
<11 mL/minute/1.73 m²	25 mg/kg/dose every 24 hours; maximum dose: 250 mg/dose	25 to 50 mg/kg/dose every 24 hours; maximum dose: 500 mg/dose	25 to 50 mg/kg/dose every 24 hours; maximum dose: 1,000 mg/dose

Hemodialysis, intermittent: Dialyzable (based on adult studies: 70% to 85% reduction in serum concentration from a 3.5- to 4-hour hemodialysis treatment with high flux filters (Ref)).

Note: Appropriate dosing requires consideration of drug penetration to site of infection, MIC of bacteria, severity of illness, residual kidney function, interval between dialysis sessions, receipt of any initial loading doses, etc. Monitor closely for response and adverse reactions due to drug accumulation (eg, neurotoxicity) (Ref).

Infants, Children, and Adolescents: IV or via dialysis circuit return line:

Intermittent (posthemodialysis) dosing: 50 mg/kg/dose following dialysis; maximum dose: 2,000 mg/dose. Note: Regimen based on 3 to 4 hour dialysis sessions at least 3 times per week. For pediatric patients receiving <3 hours of hemodialysis, consider further dose reduction (Ref).

Daily dosing (when scheduled dose falls on a dialysis day, administer after dialysis): Initial (day 1): 50 mg/kg (maximum dose: 1,000 mg/dose) followed by 12.5 to 25 mg/kg/dose once daily. Note: Maintenance and maximum doses are determined based on the usual recommended dose for patient-specific clinical scenario; recommended doses are as follows: If usual recommended dose is 50 mg/kg/dose every 8 hours, use 25 mg/kg/dose (maximum dose: 1,000 mg/dose) once daily; if usual recommended dose is 50 mg/kg/dose every 12 hours, use 12.5 mg/kg/dose (maximum dose: 500 mg/dose) once daily (Ref).

Peritoneal dialysis (manual or automated):

Note: Appropriate dosing requires consideration of drug penetration to site of infection, MIC of bacteria, severity of illness, residual kidney function, receipt of any initial loading doses, etc. Monitor closely for response and adverse reactions due to drug accumulation (eg, neurotoxicity) (Ref).

Infants, Children, and Adolescents: IV, IM: 25 to 50 mg/kg/dose every 48 hours. Usual maximum dose: 1,000 mg/dose; in severe infections or for bacteria with elevated MICs, 2,000 mg/dose maximum may be considered. Alternatively, 25 to 50 mg/kg/dose every 24 hours may be considered for severe infections (eg, septic shock) (Ref).

CRRT:

Infants, Children, Adolescents:

Note: Drug clearance is dependent on the effluent flow rate, filter type, and method of renal replacement. Recommendations are based on high-flux dialyzers and effluent flow rates of ~2,000 mL/hour/1.73 m² unless otherwise noted. Appropriate dosing requires consideration of drug penetration to site of infection, MIC of bacteria, severity of illness, receipt of any initial loading doses, etc. Monitor closely for response and adverse reactions due to drug accumulation (eg, neurotoxicity) (Ref). Due to minimal data in pediatric patients receiving CRRT, consider monitoring serum concentrations (eg, trough concentration) if available.

CVVH/CVVHD/CVVHDF: IV: 50 mg/kg/dose (maximum dose: 2,000 mg/dose) every 8 to 12 hours. Note: Adult data suggest that in severe infections or sepsis, the risks/benefits favor dosing on the higher side of the recommended frequency. For higher effluent rates (>2,000 mL/hour/1.73 m²), bacteria with higher MICs, or deep-seated infections in severely ill pediatric patients, consider extended infusions or more frequent administration (Ref).

Dosing: Hepatic Impairment: Pediatric

No dosage adjustments necessary.

Adverse Reactions (Significant): Considerations

Clostridioides difficile infection

Clostridioides difficile infection (CDI) has been reported with use in adult and pediatric patients (Ref). In one retrospective cohort study, cefepime and meropenem increased CDI risk relative to piperacillin-tazobactam (Ref).

Mechanism: Dose- and time-related; potentially related to recent or cumulative antibiotic exposure. Cefepime may cause disruption of the intestinal microbiota resulting in the overgrowth of pathogens, such as C. difficile (Ref).

Onset: Varied; may start on the first day of antibiotic therapy or up to 3 months postantibiotic (Ref).

Risk factors:

• Antibiotic exposure (highest risk factor) (Ref)

• Type of antibiotic (third-/fourth-generation cephalosporins among the highest risk) (Ref)

• Long durations in a hospital or other health care setting (recent or current) (Ref)

• Older patients (Ref)

• Immunocompromised conditions (Ref)

• A serious underlying condition (Ref)

• GI surgery/manipulation (Ref)

• Antiulcer medications (eg, proton pump inhibitors, H2 blockers) (Ref)

• Chemotherapy (Ref)

Hypersensitivity reactions (immediate and delayed)

Immediate hypersensitivity reactions (including anaphylaxis, angioedema, and urticaria) (Ref) and delayed hypersensitivity reactions have been reported. Delayed hypersensitivity reactions range from maculopapular skin rash to rare severe cutaneous adverse reactions (SCARs), including acute generalized exanthematous pustulosis, drug reaction with eosinophilia and systemic symptoms, Stevens-Johnson syndrome, and toxic epidermal necrolysis (Ref).

Mechanism: Non–dose-related; immunologic. Immediate hypersensitivity reactions (eg, anaphylaxis, angioedema, urticaria) are IgE-mediated (Ref). Delayed hypersensitivity reactions, including maculopapular rash and SCARs, are mediated by T-cells (Ref).

Onset: Immediate hypersensitivity reactions (eg, anaphylaxis, angioedema, urticaria): Rapid; generally occur within 1 hour of administration but may occur up to 6 hours after exposure (Ref). Delayed hypersensitivity reactions: Varied; maculopapular reactions typically occur 7 to 10 days after initiation. Other delayed hypersensitivity reactions, including SCARs, may occur 7 to 14 days up to 3 months after initiation (Ref).

Risk factors:

• Cross-reactivity between penicillins and cephalosporins, and among cephalosporins, is mainly related to side chain similarity (Ref).

• Potential cross-reactions may occur between cefepime, ceftriaxone, cefuroxime, ceftazidime, and cefotaxime (Ref).

Neurotoxicity

Cefepime-induced neurotoxicity (CIN) may occur and has been reported with use in adult and pediatric patients, including altered mental status, aphasia, encephalopathy, impaired consciousness, myoclonus, seizure, and nonconvulsive status epilepticus (Ref). Resolution of symptoms has been reported a median of 2 to 3 days after intervention (Ref).

Mechanism: Not clearly established; may be associated with concentration-dependent inhibition of GABA_A-mediated neurotransmission (Ref)

Onset: Rapid; a median of 2 to 4 days after initiation has been reported (Ref).

Risk factors:

• Excessive dosing; however, may also occur at appropriately adjusted doses (eg, for kidney impairment) (Ref)

• Elevated C_min (trough) concentrations and risk increases with increasing C_min(Ref)

• Kidney impairment (Ref)

• Older age (Ref)

• Preexisting brain injury (Ref)

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

>10%: Hematologic & oncologic: Positive direct Coombs test (without hemolysis: 16%)

1% to 10%:

Dermatologic: Pruritus (≤1%), skin rash (1% to 4%)

Endocrine & metabolic: Hypophosphatemia (3%)

Gastrointestinal: Diarrhea (≤3%), nausea (≤2%), vomiting (≤1%)

Hematologic & oncologic: Abnormal partial thromboplastin time (2%), change in prothrombin time (1%), eosinophilia (2%)

Hepatic: Increased serum alanine aminotransferase (3%), increased serum aspartate aminotransferase (2%)

Hypersensitivity: Hypersensitivity reaction (in patients with a history of penicillin allergy: ≤10%)

Local: Localized phlebitis (1%)

Nervous system: Headache (≤1%)

Miscellaneous: Fever (≤1%)

<1%:

Dermatologic: Erythema of skin, urticaria

Endocrine & metabolic: Hypercalcemia, hyperkalemia, hyperphosphatemia, hypocalcemia

Gastrointestinal: Clostridioides difficile colitis, oral candidiasis

Genitourinary: Vaginitis

Hematologic & oncologic: Anemia

Hepatic: Increased serum alkaline phosphatase, increased serum bilirubin

Local: Local inflammation, local pain

Renal: Increased blood urea nitrogen, increased serum creatinine

Postmarketing:

Dermatologic: Acute generalized erythematous pustulosis (Botelho 2010), Stevens-Johnson syndrome (Marco-del Rio 2017)

Gastrointestinal: Clostridioides difficile-associated diarrhea (Thabit 2019)

Hematologic & oncologic: Agranulocytosis (Medrano-Casique 2015), leukopenia (Jauregui 1993), neutropenia (Malincarne 2010), thrombocytopenia (Lim 2011)

Hepatic: Cholestatic hepatitis (Malhotra 2023, Yang 2022)

Hypersensitivity: Anaphylaxis (Moreno 2007), angioedema (Orhan 2004), drug reaction with eosinophilia and systemic symptoms (Qadri 2017)

Nervous system: Neurotoxicity (including abnormal gait [Shah 2021], agitation [Hambrick 2022], altered mental status [Payne 2017], aphasia [Isitan 2017], coma [Sonck 2008], confusion [Triplett 2019], encephalopathy [Triplett 2019], fine motor control disorder [Shah 2021], hallucination [Lamoth 2010], impaired consciousness [Payne 2017], myoclonus [Lizarraga 2019], seizure [Triplett 2019], slurred speech [Khorasani-Zadeh 2020], status epilepticus [nonconvulsive] [Garin 2019], stupor [Kim 2013], tremor [Hambrick 2022])

Renal: Acute interstitial nephritis (Qadri 2017)

Respiratory: Eosinophilic pneumonitis (Jones 2021)

Contraindications

Hypersensitivity to cefepime, other cephalosporins, penicillins, other beta-lactam antibiotics, or any component of the formulation

Warnings/Precautions

Concerns related to adverse effects:

• Elevated INR: May be associated with increased INR, especially in nutritionally deficient patients, prolonged treatment, liver or renal disease.

• Superinfection: Prolonged use may result in fungal or bacterial superinfection.

Disease-related concerns:

• Seizure disorders: Use with caution in patients with a history of seizure disorder.

Special populations:

• Older adult: Serious adverse reactions have occurred in elderly patients with renal insufficiency given unadjusted doses of cefepime, including life-threatening or fatal occurrences of encephalopathy, myoclonus, and seizures.

Warnings: Additional Pediatric Considerations

The manufacturer does not recommend the use of cefepime in pediatric patients for the treatment of serious infections due to Haemophilus influenzae type b, for suspected meningitis, or for meningeal seeding from a distant infection site. However, cefepime has been shown to achieve adequate concentrations in the cerebrospinal fluid and has been evaluated in the treatment of CNS infections (including those caused by H. influenzae type b) (Ellis 2007; Sáez-Llorens 1995; Sáez-Llorens 2001; Sullins 2013). It is currently recommended for empiric treatment of health care-associated ventriculitis or meningitis, in combination with vancomycin, or for the directed treatment of susceptible bacterial meningitis (including that caused by Pseudomonas aeruginosa) (IDSA [Tunkel 2004]; IDSA [Tunkel 2017]).

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Intravenous, as hydrochloride:

Generic: 2 g/100 mL (100 mL)

Solution, Intravenous, as hydrochloride [preservative free]:

Generic: 1 g/50 mL (50 mL)

Solution Reconstituted, Injection, as hydrochloride [preservative free]:

Generic: 1 g (1 ea)

Solution Reconstituted, Intravenous, as hydrochloride [preservative free]:

Generic: 2 g (1 ea); 100 g (1 ea); 1-5 GM-%(50ML) (1 ea); 2-5 GM-%(50ML) (1 ea)

Generic Equivalent Available: US

Yes

Pricing: US

Solution (Cefepime HCl Intravenous)

1 gm/50 mL (per mL): $0.65

2 g/100 mL (per mL): $0.51

Solution (reconstituted) (Cefepime HCl Injection)

1 g (per each): $3.10 - $20.33

Solution (reconstituted) (Cefepime HCl Intravenous)

2 g (per each): $5.76 - $40.36

100 g (per each): $570.00

Solution (reconstituted) (Cefepime-Dextrose Intravenous)

1GM 5%(50ML) (per each): $23.62

2GM 5%(50ML) (per each): $35.82

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution Reconstituted, Injection, as hydrochloride:

Generic: 1 g (1 ea); 2 g (1 ea)

Administration: Adult

IM: Inject deep IM into large muscle mass.

IV: Administer as an intermittent infusion over 30 minutes. For extended-infusion administration (off-label method), administer over 3 to 4 hours (Ref).

IV push: Limited data with IV push administration over 2 to 5 minutes at concentrations of 40 to 200 mg/mL have demonstrated this method to be generally safe and tolerable, but outcomes have not been assessed (Ref).

Intraperitoneal (off-label route): May administer intermittently (1 exchange daily; allow to dwell ≥6 hours) or continuously (with every exchange) (Ref).

Administration: Pediatric

Parenteral:

Intermittent IV infusion: Administer as an intermittent IV infusion over 30 minutes.

Extended IV infusion: Administer over 3 to 4 hours (Ref).

IV push: In adults, limited data with IV push administration over 2 to 5 minutes at concentrations of 40 to 200 mg/mL have demonstrated this method to be generally safe and tolerable, but clinical outcomes have not been assessed (Ref).

IM: Administer by deep IM injection into large muscle mass.

Use: Labeled Indications

Intra-abdominal infection, health care-associated or high-risk community-acquired infection: Treatment, in combination with metronidazole, of complicated intra-abdominal infections caused by Escherichia coli, viridans group streptococci, Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterobacter species, or Bacteroides fragilis.

Neutropenic fever: Empiric treatment of febrile neutropenic patients.

Pneumonia (moderate to severe): Treatment of moderate to severe pneumonia caused by Streptococcus pneumoniae, including cases associated with concurrent bacteremia, P. aeruginosa, K. pneumoniae, or Enterobacter species.

Skin and soft tissue infection: Treatment of moderate to severe skin and soft tissue infections caused by Staphylococcus aureus (methicillin-susceptible isolates only) or Streptococcus pyogenes.

Urinary tract infection, complicated (pyelonephritis or urinary tract infection with systemic signs/symptoms): Treatment of urinary tract infections, including pyelonephritis, caused by E. coli, K. pneumoniae, or Proteus mirabilis, including cases associated with concurrent bacteremia with these microorganisms.

Use: Off-Label: Adult

Bloodstream infection (gram-negative bacteremia); Cystic fibrosis, exacerbation; Diabetic foot infection, moderate to severe; Intracranial abscess (brain abscess, intracranial epidural abscess) and spinal epidural abscess; Meningitis, bacterial; Neutropenic enterocolitis (typhlitis); Osteomyelitis and/or discitis; Prosthetic joint infection; Sepsis and septic shock; Septic arthritis

Medication Safety Issues

Sound-alike/look-alike issues:

Cefepime may be confused with cefixime, cefTAZidime

Older Adult: High-Risk Medication:

Cefepime is identified in the Screening Tool of Older Person's Prescriptions (STOPP) criteria as a potentially inappropriate medication in older adults (≥65 years of age) for use in asymptomatic bacteriuria (O’Mahony 2023).

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Aminoglycosides: Cephalosporins may enhance the nephrotoxic effect of Aminoglycosides. Cephalosporins may decrease the serum concentration of Aminoglycosides. Risk C: Monitor therapy

Bacillus clausii: Antibiotics may diminish the therapeutic effect of Bacillus clausii. Management: Bacillus clausii should be taken in between antibiotic doses during concomitant therapy. Risk D: Consider therapy modification

BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Risk X: Avoid combination

BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization). Risk C: Monitor therapy

Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. Risk X: Avoid combination

Fecal Microbiota (Live) (Oral): May diminish the therapeutic effect of Antibiotics. Risk X: Avoid combination

Fecal Microbiota (Live) (Rectal): Antibiotics may diminish the therapeutic effect of Fecal Microbiota (Live) (Rectal). Risk X: Avoid combination

Furosemide: May enhance the nephrotoxic effect of Cephalosporins. Risk C: Monitor therapy

Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies): Antibiotics may diminish the therapeutic effect of Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies). Risk C: Monitor therapy

Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Risk C: Monitor therapy

Mycophenolate: Antibiotics may decrease serum concentrations of the active metabolite(s) of Mycophenolate. Specifically, concentrations of mycophenolic acid (MPA) may be reduced. Risk C: Monitor therapy

Probenecid: May increase the serum concentration of Cephalosporins. Risk C: Monitor therapy

Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Risk D: Consider therapy modification

Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Avoid use of live attenuated typhoid vaccine (Ty21a) in patients being treated with systemic antibacterial agents. Postpone vaccination until 3 days after cessation of antibiotics and avoid starting antibiotics within 3 days of last vaccine dose. Risk D: Consider therapy modification

Vitamin K Antagonists (eg, warfarin): Cephalosporins may enhance the anticoagulant effect of Vitamin K Antagonists. Risk C: Monitor therapy

Pregnancy Considerations

Cefepime crosses the placenta (Ozyuncu 2010).

An increased risk of major birth defects or other adverse fetal or maternal outcomes has generally not been observed following use of cephalosporin antibiotics during pregnancy.

When an antibiotic is needed for the treatment of maternal infection, cefepime can be considered. However, other, more well-studied cephalosporins are preferred for use in pregnancy (Betschart 2020; ERS/TSANZ [Middleton 2020]; Panchaud 2016).

Breastfeeding Considerations

Cefepime is present in breast milk

The manufacturer reports a breast milk concentration of 0.5 mcg/mL, providing cefepime ~0.5 mg/day to a breastfeeding infant ingesting ~1,000 mL of human milk daily. Cefepime breast milk concentrations remained at ~0.5 mcg/mL for 8 hours following the maternal dose, then decreased until becoming undetectable between 12 and 24 hours after the dose. Cefepime pharmacokinetics were similar between lactating and nonlactating patients

In general, antibiotics that are present in breast milk may cause non–dose-related modification of bowel flora. Monitor infants for GI disturbances, such as thrush or diarrhea. Breastfeeding may continue when otherwise appropriate, however discontinuing the antibiotic or changing to an alternate maternal therapy may be needed (WHO 2002).

According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and the benefits of treatment to the mother.

Monitoring Parameters

Monitor renal function. Observe for signs and symptoms of anaphylaxis during first dose.

Mechanism of Action

Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysis and murein hydrolases) while cell wall assembly is arrested.

Pharmacokinetics (Adult Data Unless Noted)

Absorption: IM: Rapid and complete.

Distribution:

V_d:

Neonates (Capparelli 2005):

PMA <30 weeks: 0.51 L/kg.

PMA >30 weeks: 0.39 L/kg.

Infants ≥2 months and children ≤11 years: 0.3 ± 0.1 L/kg.

Adults: 18 L, 0.26 L/kg; penetrates into inflammatory fluid at concentrations ~80% of serum concentrations and into bronchial mucosa at concentrations ~60% of plasma concentrations; crosses the blood-brain barrier.

Cerebrospinal fluid (CSF):

Neonates (Ellis 2007):

Preterm (n=2): CSF:serum ratio (C_min): ~30% to 87.6%.

Term (n=7): CSF:serum ratio (C_min): ~3.1% to 59.7%.

Infants ≥2 months, Children, and Adolescents ≤15 years: CSF:serum ratio: 9% at 30 minutes after dose, increasing to 67% at 8 hours after dose (Sáez-Llorens 1995).

Adults: CSF:serum ratio: 4% to 34% (AUC); 5% to 58% (C_min) (Rhoney 2003).

Lung:

Epithelial lining fluid:serum ratio: ~100% (Boselli 2003; Breilh 2001).

Protein binding, plasma: ~20%.

Metabolism: Minimally hepatic.

Half-life elimination:

Neonates: 4 to 5 hours (Lima-Rogel 2008).

Children 2 months to 6 years of age: 1.77 to 1.96 hours.

Adults: 2 hours.

Hemodialysis: 13.5 hours.

Continuous peritoneal dialysis: 19 hours.

Time to peak: IM: 1 to 2 hours; IV: 0.5 hours.

Excretion: Urine (85% as unchanged drug).

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Altered kidney function: Total body clearance is decreased proportionally with creatinine clearance.

Anti-infective considerations:

Parameters associated with efficacy: Time dependent; associated with time free drug concentration (fT) > minimum inhibitory concentration (MIC).

Infusion specific:

Standard infusion and up to 4 hours extended infusion: Goal: 40% to 70% fT > MIC (Hong 2023).

Continuous infusion: Goal: 100% fT > MIC with concentrations that exceed up to 4 to 8 times free drug over the steady-state concentration (fCss) (Hong 2023).

Organism specific:

Staphylococcus spp.: Goal: 40% fT > MIC (bactericidal in vitro) (Craig 1995).

Streptococcus spp.: Goal: 40% fT > MIC (bacteriostatic in vitro), 60% to 70% fT > MIC (bactericidal in vitro) (Craig 1995).

Gram negative bacteria (including P. aeruginosa): Goal: 40% fT > MIC (bacteriostatic in vitro); 60% to 70% fT > MIC (bactericidal in vitro); 53% to 60% fT > MIC (microbiological response) (Craig 1995; Craig 1998; Crandon 2010; MacVane 2014a; Roos 2006).

Population specific:

Critically ill patients in the ICU: Minimum goal: ≥50% fT > MIC; preferred goal: ≥100% fT > MIC (Roberts 2014); some experts favor ≥100% fT >4 times the MIC (Guilhaumou 2019).

Postantibiotic effect: Generally little to no postantibiotic effect for Streptococcus spp. and gram negative bacilli (including P. aeruginosa); prolonged postantibiotic effect for Staphylococcus spp. (Craig 1991; Craig 1995; Craig 1998; Ozbek 2009).

Parameters associated with toxicity: Neurotoxicity (eg, confusion, altered consciousness, seizures) is associated with elevated C_min (trough) concentrations and risk increases with increasing C_min; however, a specific C_min associated with neurotoxicity has not been well established (Boschung-Pasquier 2020; Huwyler 2017; Lamoth 2010; Payne 2017). In 2 small studies, C_min of ≥22 mg/L and >35 mg/L were associated with neurotoxicity (Huwyler 2017; Lamoth 2010). In a study assessing cefepime therapeutic drug monitoring in adults, C_min <7.7 mg/L resulted in no neurotoxicity, C_min ≥12 mg/L was associated with a 25% probability of neurotoxicity, C_min ≥16 mg/L was associated with a 50% probability of neurotoxicity, and C_min ≥38.1 mg/L was always associated with neurotoxicity (Boschung-Pasquier 2020). A meta-analysis found a cefepime trough level of >20 mg/L puts patients at risk for cefepime-induced neurotoxicity (Maan 2022).

Expected drug concentrations in patients with normal renal function:

Neonates (Shoji 2016): C_max(peak): IV:

GA <36 weeks: ~50 mg/kg/dose every 12 hours, steady state: 190.02 ± 31.25 mg/L.

GA ≥36 weeks: ~50 mg/kg/dose every 12 hours, steady state: 192.92 ± 19.64 mg/L.

Infants and children 2 months to 16 years of age; hospitalized: C_max (peak): IV:

50 mg/kg/dose every 8 hours, steady state: 184.2 ± 38 mg/L (Reed 1997).

Adults: C_max (peak): IV:

30-minute infusion, healthy volunteers:

1 g, single dose: 81.7 ± 5.1 mg/L.

1 g every 8 hours, steady state (day 6): 70.5 ± 8.5 mg/L (Barbhaiya 1992).

2 g, single dose: 163.9 ± 25.3 mg/L.

2 g every 8 hours, steady state (day 6): 129 ± 27.1 mg/L (Barbhaiya 1992).

4-hour infusion, hospitalized patients requiring antibiotics:

1 g every 8 hours, steady state: 32.5 ± 13.5 mg/L (Cheatham 2011).

Brand Names: International

International Brand Names by Country

For country code abbreviations (show table)

(AE) United Arab Emirates: Maxipime | Pozineg | Protec | Qpime;
(AR) Argentina: Cefepime northia | Cefepime pharmavia | Cefepime richet | Cefimen K | Fada cefepime | Maxcef | Rivepime;
(AT) Austria: Cefepim Amomed | Cefepim mip | Cefepim Sandoz | Cefepime accord | Maxipime;
(AU) Australia: Cefepime aft | Cefepime alphapharm | Cefepime Kabi | DBL Cefepime | Maxipime | Omegapharm Cefepime;
(BD) Bangladesh: Axepime | Cefa 4 | Ceftipime | Efepime | Forgen | Japime | Magnova | Maxpime | Megapime | Superpime | Tetracef | Ultrapime | Winnipime | Xenim | Ximepime | Zopime;
(BE) Belgium: Cefepim Fresenius Kabi | Cefepim mip | Cefepim Sandoz | Cefepime ldp laboratorios torlan | Cefepime noridem | Maxipime;
(BF) Burkina Faso: Kefpime | Pozineg | Zipime;
(BG) Bulgaria: Alphacef | Bacteripime | Cefepim | Cefepime Kabi | Cefepime panpharma | Critipime | Maxipime;
(BR) Brazil: Cefepima Cloridrato | Cemax | Cloridrato de cefepima | Cloridrato de cefepime | Maxcef | Nepecef;
(CH) Switzerland: Cefepim Sandoz | Cefepime Orpha | Maxipime;
(CI) Côte d'Ivoire: Kefpime | Micropime | Pozineg | Sanpime | Ultrapime | Zipime;
(CL) Chile: Cefepima | Maxipime;
(CN) China: Cefepime dihydrochloride | Da li neng | Heng su | Ka luo xin | Kang li wo pu | Lai bi xin | Li si ping | Maxipime | Maxipimg | Pai nai xin | Xin li wei;
(CO) Colombia: Cefdeltime | Cefemin | Cefepima | Cefepime | Imation | Maxipime | Pimecef | Pozineg | Salapime;
(CZ) Czech Republic: Cefepim noridem | Cefepime accord | Maxipime;
(DE) Germany: Cefepim mip | Cefepim panpharma | Cefepim qilu | Cefepim stragen | Cefepime rotexmedica | Maxipime;
(DO) Dominican Republic: Cefepima | Cefepime | Cefepime sintesis | Cefime | Cipime | Efectus | Kabol | Maxipime | Pramur;
(EC) Ecuador: Cefepima | Cefepime | Cefepime richet | Cefimen-k | Maxipime;
(EE) Estonia: Alphacef | Cefepime | Cefepime norameda | Maxipime | Renapime;
(EG) Egypt: Cefepime | Cepimax | Curafep | Forcetex | Kempopim | Maxipime | Pimfast | Vanzapro | Wincef | Zovijectin;
(ES) Spain: Cefepima | Cefepima combino | Cefepima hospira | Cefepima kabi | Cefepima normon | Cefepima qilu | Cefepima sala | Maxipime;
(ET) Ethiopia: Cefepime HCL | Injpime | Necpime | Pozineg | Protec | Sanpime;
(FI) Finland: Cefepim MIP Pharma | Cefepime norameda | Maxipime;
(FR) France: Axepim | Cefepime accord | Cefepime Dci | Cefepime gerda | Cefepime Mylan | Cefepime noridem | Cefepime panpharma | Cefepime stragen;
(GB) United Kingdom: Renapime;
(GR) Greece: Cefepime/alvia | Cefepime/kabi | Gencef | Maxinject | Maxipime | Verapime | Zefipime;
(HK) Hong Kong: Maxipime;
(HR) Croatia: Cefepime Kabi | Maxipime;
(HU) Hungary: Cefepima normon | Cefepime mip | Maxipime;
(ID) Indonesia: Actacef | Biocepime | Caprifim | Cefepime | Cefinov | Daryacef | Emax | Exepime | Falocef | Futapim | Interpim | Macef | Maxicef | Maxilan | Maximer | Maxipime | Procepim | Sandocef | Sopime | Vipime;
(IL) Israel: Maxcef;
(IN) India: Adpime | Atlapime | Biopime | Blucef XL | C pime | Cachepime | Cefdiel-i | Cefeprime | Ceficad | Cefpy | Celrim | Cepime | Cepy | Epime | Forpar | Ivipime | Kefage | Kefpime | Kepime | Kingcef | Mapime | Maxicef | Maxopime | Megapime | Micropime | Nitipime | Novapime | Orpime | Pozineg | Pryme | Radipime | Refpim | Safepime | Scud | Sefdin | Ultipime | Vegapime | Winpime | Zipime | Zwiter;
(IT) Italy: Cepim | Cepimex | Maxipime;
(JO) Jordan: Cepim | Maxipime;
(JP) Japan: Cefepime HCL | Cefepime hydrochloride Cmx | Maxipime bristol myers | Maxipime meiji;
(KE) Kenya: C pime | Cefepimark | Ceficad | Ceftipime | Forpar | Injpime | Inno pime | Kopime | Maxime | Megapime | Micropime | Necpime | Pimcef | Pimefast | Pozineg | Skypime | Teico | Totacef | Ultrapime;
(KR) Korea, Republic of: Acepime | Alvogen cefepime hcl | Cefem | Maxipime boryung | Newcepim | Newsepim;
(KW) Kuwait: Deltacef | Maxipime | Protec;
(LB) Lebanon: Cefepime panpharma | Cefipex | Maxipime | Qpime;
(LT) Lithuania: Cefepime mip | Cefepime norameda | Maxipime;
(LU) Luxembourg: Maxipime;
(LV) Latvia: Cefepime mip | Cefepime norameda | Maxipime | Salapime;
(MA) Morocco: Protec;
(MX) Mexico: Cefepima | Feriticefin | Imation | Makenpime | Maxef | Maxipime | Pimerzen | Pozineg | Suloval | Toblefam | Vipefime;
(MY) Malaysia: Cefepen | Ceficad | Cefmex | Forpar | Maxipime | Sefepim | Verapime;
(NG) Nigeria: Asceftra;
(NO) Norway: Cefepim;
(NZ) New Zealand: Cefepime | Cefepime aft | Cefepime Kabi | DBL Cefepime | Maxipime;
(OM) Oman: Protec;
(PE) Peru: Cefepima | Cefepimek | Maxipime | Megapime | Norcef | Pimcef;
(PH) Philippines: 4 gen 1000 | Alcemax | Altamax | Axera | Cefepime | Cefevex | Cefime | Cepimax | Cepiram | Dimipra | Extemax | Kevon | Medipime | Megapime | Neupime | Pimevex | Pozineg | Sanpime | Sefepim | Sefpime | Sepime | Spectrax | Stafipime | Supime | Vipefime | Zepim;
(PK) Pakistan: Adpime | Afipime | Aleeva | Alipime | Axepime | Axipime | Baxipime | Cef hy | Cefevial | Cefgram | Cefi | Cefigen | Cefipar | Cefipime | Cefstar | Cerapime | Daypime | Dizma 4 | Elide | Emipref | Emty | Endopime | Feldopim | Fredipime | Gepin | Gu pime | Jewpime | Kanpime | Magnapime | Markpime | Maxipime | Maxpin | Maxum | Medipime | Megapime | Mepime | Neupime | New pime | Novapime | Nuxipim | Olipime | On cef | Palfepim | Pefmad | Perin | Pimalin | Pimazon | Pime | Pimecef | Pimeranis | Pimerive | Pimestar | Pimporin | Puna | Siodime | Solopime | Swisspime | Uceph | Unipime | Uspime | Vegapime | Verapime | Voco | Winpime | Zepim;
(PL) Poland: Cefepim MIP Pharma | Cefepime Kabi | Cefepime panpharma | Critipeme | Maxipime;
(PR) Puerto Rico: Cefepime | Cefepime HCL | Maxipime;
(PT) Portugal: Cefepima accord | Cefepima basi | Cefepima hospira | Cefepima kabi | Cefepima normon | Maxipime;
(PY) Paraguay: Acedrin | Cefepima libra | Cefepima medicine | Cefepima vmg | Cefepime prosalud | Cefepime richet | Cefinina | Clorhidrato de cefepima | Fada cefepime;
(QA) Qatar: Cepim | Deltacef | Ekipim | Pozineg | Protec;
(RO) Romania: Cefepime Kabi;
(RU) Russian Federation: Cefepim | Cefepime | Cefepime agio | Cefepime alkem | Cefepime jodas | Cefepime vial | Cefomax | Cepim | Cling | Decefim | Efipime | Kefsepim | Ladef | Maxicef | Maxipime | Maxycef | Movizar;
(SA) Saudi Arabia: Cefepime | Deltacef | Maxipime | Vanzapro;
(SE) Sweden: Cefepim mip | Maxipime;
(SG) Singapore: Maxipime;
(SI) Slovenia: Cefepim kabi | Maxipime;
(SK) Slovakia: Cefepim noridem | Maxipime;
(TH) Thailand: Aspime | Cefamax | Maxipime | Megapime | Orpime | Pime | Sefpime;
(TR) Turkey: Avipim | Ekipim | Maxipime | Roxipime | Unisef;
(TW) Taiwan: Antifect | Cefemax | Cefepime | Cefepin | Cefim | Funjapin | Macepim | Maxipime | Supecef | Tisan | Yupime;
(UA) Ukraine: Abypim | Blipime | Brodipime | Cebopime | Cefepim | Cefepime | Cefepime vista | Cefepimum | Ceficad | Cefimek | Cefotrine | Cepim | Espim | Exipime | Extencef | Fortacef | Kefpime | Maxinort | Maxipim | Megapim | Novapim | Pikcef | Pozineg | Quadrocef | Quartacef | Roxipim | Sanpime | Septipim | Ukpime 1000;
(UG) Uganda: Ceficad | Megapime | Necpime | Pimcef | Pozineg | Sanpime | Teico | Vaxcel cefepime | Welzpime;
(UY) Uruguay: Cefepime northia | Cepim | Maxcef;
(VE) Venezuela, Bolivarian Republic of: Cefepima | Forpar | Maxipime | Necpime | Pimcef | Sanpime;
(VN) Viet Nam: Bapexim | Capime | Cefeme | Cefpas | Dixapim | Shinfemax | Vipimax;
(ZA) South Africa: Auro cefepime | Cefepime actor | Cefepime safeline | Critipeme | Maxipime;
(ZM) Zambia: Forcepime | Micropime | Necpime | Novapime | Orpime

Abdul-Aziz MH, Sulaiman H, Mat-Nor MB, et al. Beta-Lactam Infusion in Severe Sepsis (BLISS): a prospective, two-centre, open-labelled randomised controlled trial of continuous versus intermittent beta-lactam infusion in critically ill patients with severe sepsis. Intensive Care Med. 2016;42(10):1535-1545. doi:10.1007/s00134-015-4188-0 [PubMed 26754759]
Ajibola O, Aremu TO, Dada SO, et al. The trend of cefepime-induced neurotoxicity: a systematic review. Cureus. 2023;15(6):e40980. doi:10.7759/cureus.40980 [PubMed 37503476]
Alkharfy KM, Kellum JA, Frye RF, Matzke GR. Effect of ceftazidime on systemic cytokine concentrations in rats. Antimicrob Agents Chemother. 2000;44(11):3217-3219. doi:10.1128/aac.44.11.3217-3219.2000 [PubMed 11036058]
Allaouchiche B, Breilh D, Jaumain H, Gaillard B, Renard S, Saux MC. Pharmacokinetics of cefepime during continuous venovenous hemodiafiltration. Antimicrob Agents Chemother. 1997;41(11):2424-2427. doi:10.1128/AAC.41.11.2424 [PubMed 9371344]
Alves MD, Ribeiro VB, Tessari JP, et al. Effect of cefepime dose on mortality of patients with gram-negative bacterial bloodstream infections: a prospective cohort study. J Antimicrob Chemother. 2014;69(6):1681-1687. doi:10.1093/jac/dku001 [PubMed 24474430]
American Academy of Pediatrics (AAP). In: Kimberlin DW, Brady MT, Jackson MA, Long SA, eds. Red Book: 2018 Report of the Committee on Infectious Diseases. 31st ed. American Academy of Pediatrics; 2018.
American Academy of Pediatrics (AAP). In: Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book: 2021 Report of the Committee on Infectious Diseases. 32nd ed. American Academy of Pediatrics; 2021.
Arguedas AG, Stutman HR, Zaleska M, et al. Cefepime. Pharmacokinetics and Clinical Response in Patients With Cystic Fibrosis. Am J Dis Child. 1992;146(7):797-802. doi:10.1001/archpedi.1992.02160190029013 [PubMed 1496945]
Arnold HM, Hollands JM, Skrupky LP, et al. Prolonged infusion antibiotics for suspected gram-negative infections in the ICU: a before-after study. Ann Pharmacother. 2013;47(2):170-180. doi:10.1345/aph.1R523 [PubMed 23341160]
Aronoff GR, Bennett WM, Berns JS, et al. Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and Children. 5th ed. American College of Physicians; 2007.
Baltimore RS, Gewitz M, Baddour LM, et al; American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young and the Council on Cardiovascular and Stroke Nursing. Infective endocarditis in childhood: 2015 update: a scientific statement from the American Heart Association. Circulation. 2015;132(15):1487-1515. doi:10.1161/CIR.0000000000000298 [PubMed 26373317]
Barbhaiya RH, Forgue ST, Gleason CR, et al. Pharmacokinetics of cefepime after single and multiple intravenous administrations in healthy subjects. Antimicrob Agents Chemother. 1992;36(3):552-557. doi:10.1128/aac.36.3.552 [PubMed 1622165]
Barlam TF, Cosgrove SE, Abbo LM, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis. 2016;62(10):e51-e77. doi:10.1093/cid/ciw118 [PubMed 27080992]
Barshak MB. Antimicrobial approach to intra-abdominal infections in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed January 6, 2023.
Bauer KA, West JE, O'Brien JM, Goff DA. Extended-infusion cefepime reduces mortality in patients with Pseudomonas aeruginosa infections. Antimicrob Agents Chemother. 2013;57(7):2907-1292. doi:10.1128/AAC.02365-12 [PubMed 23571547]
Beauchamp LC, Nichols KR, Knoderer CA. Outcomes of extended infusion cefepime in pediatric patients. Infect Dis Clin Pract. 2019;27(5):283-287.
Behal ML, Thomas JK, Thompson Bastin ML, Mefford BM. Cefepime induced neurotoxicity following a regimen dose-adjusted for renal function: case report and review of the literature. Hosp Pharm. 2022;57(3):385-391. doi:10.1177/00185787211046856 [PubMed 35615483]
Berbari E, Baddour LM, Chen AF. Prosthetic joint infection: Treatment. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 10, 2023.
Berbari EF, Kanj SS, Kowalski TJ, et al; Infectious Diseases Society of America. 2015 Infectious Diseases Society of America (IDSA) clinical practice guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults. Clin Infect Dis. 2015;61(6):e26-e46. doi:10.1093/cid/civ482 [PubMed 26229122]
Betschart C, Albrich WC, Brandner S, et al. Guideline of the Swiss Society of Gynaecology and Obstetrics (SSGO) on acute and recurrent urinary tract infections in women, including pregnancy. Swiss Med Wkly. 2020;150:w20236. doi:10.4414/smw.2020.20236 [PubMed 32365216]
Beumier M, Casu GS, Hites M, et al. β-lactam antibiotic concentrations during continuous renal replacement therapy. Crit Care. 2014;18(3):R105. doi:10.1186/cc13886 [PubMed 24886826]
Blumenthal KG, Peter JG, Trubiano JA, Phillips EJ. Antibiotic allergy. Lancet. 2019;393(10167):183-198. doi:10.1016/S0140-6736(18)32218-9 [PubMed 30558872]
Bodilsen J, Brouwer MC, Nielsen H, Van De Beek D. Anti-infective treatment of brain abscess. Expert Rev Anti Infect Ther. 2018;16(7):565-578. doi:10.1080/14787210.2018.1489722 [PubMed 29909695]
Bond A, Manian FA. Spinal epidural abscess: a review with special emphasis on earlier diagnosis. Biomed Res Int. Published online December 1, 2016. doi:10.1155/2016/1614328 [PubMed 28044125]
Boschung-Pasquier L, Atkinson A, Kastner LK, et al. Cefepime neurotoxicity: thresholds and risk factors. A retrospective cohort study. Clin Microbiol Infect. 2020;26(3):333-339. doi:10.1016/j.cmi.2019.06.028 [PubMed 31284030]
Boselli E, Breilh D, Duflo F, et al. Steady-state plasma and intrapulmonary concentrations of cefepime administered in continuous infusion in critically ill patients with severe nosocomial pneumonia. Crit Care Med. 2003;31(8):2102-2106. doi:10.1097/01.CCM.0000069734.38738.C8 [PubMed 12973166]
Botelho LF, Picosse FR, Padilha MH, Michalany N, Góis A, Porro AM. Acute generalized exanthematous pustulosis induced by cefepime: a case report. Case Rep Dermatol. 2010;2(2):82-87. doi:10.1159/000314474 [PubMed 21103192]
Bradley JS, Nelson JD, Kimberlin DK, et al, eds. Nelson's Pocket Book of Pediatric Antimicrobial Therapy. 28th ed. American Academy of Pediatrics; 2022.
Breilh D, Saux MC, Delaisement C, et al. Pharmacokinetic population study to describe cefepime lung concentrations. Pulm Pharmacol Ther. 2001;14(2):69-74. doi:10.1006/pupt.2000.0269 [PubMed 11273786]
Brockow K, Przybilla B, Aberer W, et al. Guideline for the diagnosis of drug hypersensitivity reactions: S2K-Guideline of the German Society for Allergology and Clinical Immunology (DGAKI) and the German Dermatological Society (DDG) in collaboration with the Association of German Allergologists (AeDA), the German Society for Pediatric Allergology and Environmental Medicine (GPA), the German Contact Dermatitis Research Group (DKG), the Swiss Society for Allergy and Immunology (SGAI), the Austrian Society for Allergology and Immunology (ÖGAI), the German Academy of Allergology and Environmental Medicine (DAAU), the German Center for Documentation of Severe Skin Reactions and the German Federal Institute for Drugs and Medical Products (BfArM). Allergo J Int. 2015;24(3):94-105. doi:10.1007/s40629-015-0052-6 [PubMed 26120552]
Brown KA, Khanafer N, Daneman N, Fisman DN. Meta-analysis of antibiotics and the risk of community-associated Clostridium difficile infection. Antimicrob Agents Chemother. 2013;57(5):2326-2332. doi:10.1128/AAC.02176-12 [PubMed 23478961]
Budh DP, Hawa S, Rios D, Chilakala A, Paniagua JA. Acute generalized exanthematous pustulosis in a setting of cutaneous lymphoma. Cureus. 2022;14(9):e29754. doi:10.7759/cureus.29754 [PubMed 36324356]
Burgess SV, Mabasa VH, Chow I, Ensom MH. Evaluating outcomes of alternative dosing strategies for cefepime: a qualitative systematic review. Ann Pharmacother. 2015;49(3):311-322. doi:10.1177/1060028014564179 [PubMed 25575975]
Capparelli E, Hochwald C, Rasmussen M, et al. Population pharmacokinetics of cefepime in the neonate. Antimicrob Agents Chemother. 2005;49(7):2760-2766. doi:10.1128/AAC.49.7.2760-2766.2005 [PubMed 15980347]
Carlier M, Taccone FS, Beumier M, et al. Population pharmacokinetics and dosing simulations of cefepime in septic shock patients receiving continuous renal replacement therapy. Int J Antimicrob Agents. 2015;46(4):413-419. doi:10.1016/j.ijantimicag.2015.05.020 [PubMed 26208469]
Cefepime injection [prescribing information]. Chicago, IL: Meitheal Pharmaceuticals Inc; November 2018.
Cefepime injection [prescribing information]. Deerfield, IL: Baxter; May 2020.
Cefepime injection [prescribing information]. Buffalo Grove, IL: Xellia Pharmaceuticals; August 2021.
Cefepime hydrochloride and dextrose [prescribing information]. Bethlehem, PA: B. Braun Medical Inc; March 2022.
Centers for Disease Control and Prevention (CDC). FAQs for clinicians about C. diff. https://www.cdc.gov/cdiff/clinicians/faq.html. Updated October 25, 2022. Accessed January 8, 2023.
Chaijamorn W, Charoensareerat T, Srisawat N, Pattharachayakul S, Boonpeng A. Cefepime dosing regimens in critically ill patients receiving continuous renal replacement therapy: a Monte Carlo simulation study. J Intensive Care. 2018;6:61. doi:10.1186/s40560-018-0330-8 [PubMed 30221005]
Cheatham SC, Shea KM, Healy DP, et al. Steady-state pharmacokinetics and pharmacodynamics of cefepime administered by prolonged infusion in hospitalised patients. Int J Antimicrob Agents. 2011;37(1):46-50. doi:10.1016/j.ijantimicag.2010.08.016 [PubMed 21074370]
Cies JJ, Moore WS 2nd, Enache A, Chopra A. β-lactam therapeutic drug management in the PICU. Crit Care Med. 2018;46(2):272-279. doi:10.1097/CCM.0000000000002817 [PubMed 29112080]
Collins CE, Ayturk MD, Flahive JM, Emhoff TA, Anderson FA Jr, Santry HP. Epidemiology and outcomes of community-acquired Clostridium difficile infections in Medicare beneficiaries. J Am Coll Surg. 2014;218(6):1141-1147.e1. doi:10.1016/j.jamcollsurg.2014.01.053 [PubMed 24755188]
Courter JD, Kuti JL, Girotto JE, Nicolau DP. Optimizing bactericidal exposure for beta-lactams using prolonged and continuous infusions in the pediatric population. Pediatr Blood Cancer. 2009;53(3):379‐385. doi:10.1002/pbc.22051 [PubMed 19422028]
Craig WA. Interrelationship between pharmacokinetics and pharmacodynamics in determining dosage regimens for broad-spectrum cephalosporins. Diagn Microbiol Infect Dis. 1995;22(1-2):89-96. doi:10.1016/0732-8893(95)00053-d [PubMed 7587056]
Craig WA. Pharmacokinetic/pharmacodynamic parameters: rationale for antibacterial dosing of mice and men. Clin Infect Dis. 1998;26(1):1-10. doi:10.1086/516284 [PubMed 9455502]
Craig WA. The postantibiotic effect. Clin Microbiol Newsletter. 1991;13(16):121-124. doi:10.1016/0196-4399(91)90030-Y
Crandon JL, Bulik CC, Kuti JL, Nicolau DP. Clinical pharmacodynamics of cefepime in patients infected with Pseudomonas aeruginosa. Antimicrob Agents Chemother. 2010;54(3):1111-1116. doi:10.1128/AAC.01183-09 [PubMed 20038614]
Cunningham JM, Sachs KV, Allyn R. Cefepime-induced neurotoxicity presenting with nonconvulsive status epilepticus admitted as a stroke alert. Am J Case Rep. 2020;21:e921643. doi:10.12659/AJCR.921643 [PubMed 32147665]
Descombes E, Martins F, Hemett OM, Erard V, Chuard C. Three-times-weekly, post-dialysis cefepime therapy in patients on maintenance hemodialysis: a retrospective study. BMC Pharmacol Toxicol. 2016;17:4. doi:10.1186/s40360-016-0048-y [PubMed 26846675]
Deshpande A, Pasupuleti V, Thota P, et al. Community-associated Clostridium difficile infection and antibiotics: a meta-analysis. J Antimicrob Chemother. 2013;68(9):1951-1961. doi:10.1093/jac/dkt129 [PubMed 23620467]
de Wijkerslooth EML, Boerma EG, van Rossem CC, et al; APPIC Study Group. 2 days versus 5 days of postoperative antibiotics for complex appendicitis: a pragmatic, open-label, multicentre, non-inferiority randomised trial. Lancet. 2023;401(10374):366-376. doi:10.1016/S0140-6736(22)02588-0 [PubMed 36669519]
Droege M, Van Fleet S, Healy D, et al. Continuous renal replacement therapy and flow rate influence on cefepime pharmacokinetics. Crit Care Med. 2013;41:12(suppl):PA244. doi:10.1097/01.ccm.0000440208.69019.76
Durand-Maugard C, Lemaire-Hurtel AS, Gras-Champel V, et al. Blood and CSF monitoring of cefepime-induced neurotoxicity: nine case reports. J Antimicrob Chemother. 2012;67(5):1297-1299. doi:10.1093/jac/dks012 [PubMed 22298349]
Ellis JM, Rivera L, Reyes G, et al. Cefepime cerebrospinal fluid concentrations in neonatal bacterial meningitis. Ann Pharmacother. 2007;41(5):900‐901. [PubMed 17426074]
Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181-1247. doi:10.1007/s00134-021-06506-y 34599691 [PubMed 34599691]
Expert opinion. Senior Obesity Editorial Team: Jeffrey F. Barletta, PharmD, FCCM; Manjunath P. Pai, PharmD, FCP; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC.
Expert opinion. Senior Renal Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
Flume PA, Mogayzel PJ Jr, Robinson KA, et al; Clinical Practice Guidelines for Pulmonary Therapies Committee. Cystic fibrosis pulmonary guidelines: treatment of pulmonary exacerbations. Am J Respir Crit Care Med. 2009;180(9):802-808. doi:10.1164/rccm.200812-1845PP [PubMed 19729669]
Fratoni AJ, Nicolau DP, Kuti JL. A guide to therapeutic drug monitoring of β-lactam antibiotics. Pharmacotherapy. 2021;41(2):220-233. doi:10.1002/phar.2505 [PubMed 33480024]
Freifeld AG, Bow EJ, Sepkowitz KA, et al; Infectious Diseases Society of America. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2011;52(4):e56-e93. doi:10.1093/cid/cir073 [PubMed 21258094]
Fugate JE, Kalimullah EA, Hocker SE, Clark SL, Wijdicks EF, Rabinstein AA. Cefepime neurotoxicity in the intensive care unit: a cause of severe, underappreciated encephalopathy. Crit Care. 2013;17(6):R264. doi:10.1186/cc13094 [PubMed 24200036]
Garin A, Bavozet F. Myoclonic status epilepticus induced by cefepime overdose requiring haemodialysis. BMJ Case Rep. 2019;12(6):e228108. doi:10.1136/bcr-2018-228108 [PubMed 31175111]
Garrelts JC, Wagner DJ. The Pharmacokinetics, Safety, and Tolerance of Cefepime Administered as an Intravenous Bolus or as a Rapid Infusion. Ann Pharmacother. 1999;33(12):1258-1261. [PubMed 10630824]
Gentry LO, Rodriguez-Gomez G. Randomized comparison of cefepime and ceftazidime for treatment of skin, surgical wound, and complicated urinary tract infections in hospitalized subjects. Antimicrob Agents Chemother. 1991;35(11):2371-2374. [PubMed 1804010]
Georges B, Conil JM, Cougot P, et al. Cefepime in critically ill patients: continuous infusion vs. an intermittent dosing regimen. Int J Clin Pharmacol Ther. 2005;43(8):360-369. doi:10.5414/cpp43360 [PubMed 16119511]
Goldenberg DL, Sexton DJ. Septic arthritis in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 10, 2023.
Gomi H, Solomkin JS, Schlossberg D, et al. Tokyo guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2018;25(1):3-16. doi:10.1002/jhbp.518 [PubMed 29090866]
Goss CH, Heltshe SL, West NE, et al; STOP2 Investigators. A randomized clinical trial of antimicrobial duration for cystic fibrosis pulmonary exacerbation treatment. Am J Respir Crit Care Med. 2021;204(11):1295-1305. doi:10.1164/rccm.202102-0461OC [PubMed 34469706]
Guilhaumou R, Benaboud S, Bennis Y, et al. Optimization of the treatment with beta-lactam antibiotics in critically ill patients-guidelines from the French Society of Pharmacology and Therapeutics (Société Française de Pharmacologie et Thérapeutique-SFPT) and the French Society of Anaesthesia and Intensive Care Medicine (Société Française d'Anesthésie et Réanimation-SFAR). Crit Care. 2019;23(1):104. doi:10.1186/s13054-019-2378-9 [PubMed 30925922]
Gupta K. Acute complicated urinary tract infection (including pyelonephritis) in adults and adolescents. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed January 31, 2024a.
Gupta K, Hooton TM, Naber KG, et al; Infectious Diseases Society of America; European Society for Microbiology and Infectious Diseases. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52(5):e103-e120. doi: 10.1093/cid/ciq257. [PubMed 21292654]
Guzman-Limon M, Amatya S, Samuels J, Swinford R, Bhatnagar S, Samuel J. Cefepime-induced neurotoxicity in a pediatric patient on chronic hemodialysis: a case report. Clin Case Rep. 2017;5(12):1931-1933. doi:10.1002/ccr3.1217 [PubMed 29225828]
Haase MR. Acute Bacterial Meningitis in Children. J Pharm Pract. 2004;17:392.
Halilovic J, Heintz BH. Antibiotic dosing in cirrhosis. Am J Health Syst Pharm. 2014;71(19):1621-1634. doi:10.2146/ajhp140031 [PubMed 25225448]
Hambrick HR, Pavia K, Tang Girdwood S, Lazear D, Taylor JM, Benoit S. Cefepime-associated neurotoxicity in a pediatric patient with stage V chronic kidney disease. J Pharm Pract. Published online September 8, 2022. doi:10.1177/08971900221125000 [PubMed 36081354]
Han EE, Beringer PM, Falck P, et al. Pilot study of continuous infusion cefepime in adult patients with cystic fibrosis. J Antimicrob Chemother. 2006;57(5):1017‐1019. [PubMed 16533828]
Haraszti S, Sendil S, Jensen N. Delayed presentation of acute generalized exanthematous pustulosis following treatment with cefepime in a patient with COVID-19 without the use of hydroxychloroquine. Am J Case Rep. 2020;21:e926901. doi:10.12659/AJCR.926901 [PubMed 33097683]
Hasbun R. Treatment of bacterial meningitis caused by specific pathogens in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 10, 2023.
Heintz BH, Matzke GR, Dager WE. Antimicrobial dosing concepts and recommendations for critically ill adult patients receiving continuous renal replacement therapy or intermittent hemodialysis. Pharmacotherapy. 2009;29(5):562-577. [PubMed 19397464]
Hensgens MP, Goorhuis A, Dekkers OM, Kuijper EJ. Time interval of increased risk for Clostridium difficile infection after exposure to antibiotics. J Antimicrob Chemother. 2012;67(3):742-748. doi:10.1093/jac/dkr508 [PubMed 22146873]
Hites M, Taccone FS, Wolff F, et al. Broad-spectrum β-lactams in obese non-critically ill patients. Nutr Diabetes. 2014;4(6):e119. doi:10.1038/nutd.2014.15 [PubMed 24956136]
Hites M, Taccone FS, Wolff F, et al. Case-control study of drug monitoring of β-lactams in obese critically ill patients. Antimicrob Agents Chemother. 2013;57(2):708-715. doi:10.1128/AAC.01083-12 [PubMed 23147743]
Hoepelman AI, Kieft H, Aoun M, et al. International comparative study of cefepime and ceftazidime in the treatment of serious bacterial infections. J Antimicrob Chemother. 1993;32(suppl B):175-186. doi:10.1093/jac/32.suppl_b.175 [PubMed 8150761]
Hong LT, Downes KJ, FakhriRavari A, et al. International consensus recommendations for the use of prolonged-infusion beta-lactam antibiotics: endorsed by the American College of Clinical Pharmacy, British Society for Antimicrobial Chemotherapy, Cystic Fibrosis Foundation, European Society of Clinical Microbiology and Infectious Diseases, Infectious Diseases Society of America, Society of Critical Care Medicine, and Society of Infectious Diseases Pharmacists. Pharmacotherapy. 2023;43(8):740-777. doi:10.1002/phar.2842 [PubMed 37615245]
Huwyler T, Lenggenhager L, Abbas M, et al. Cefepime plasma concentrations and clinical toxicity: a retrospective cohort study. Clin Microbiol Infect. 2017;23(7):454-459. doi:10.1016/j.cmi.2017.01.005 [PubMed 28111294]
Isitan C, Ferree A, Hohler AD. Cefepime induced neurotoxicity: a case series and review of the literature. eNeurologicalSci. 2017;8:40-43. doi:10.1016/j.ensci.2017.08.001 [PubMed 29260037]
Jang SM, Gharibian KN, Lewis SJ, Fissell WH, Tolwani AJ, Mueller BA. A Monte Carlo simulation approach for beta-lactam dosing in critically ill patients receiving prolonged intermittent renal replacement therapy. J Clin Pharmacol. 2018;58(10):1254-1265. doi: 10.1002/jcph.1137 [PubMed 29746711]
Jauregui L, Matzke D, Scott M, Minns P, Hageage G. Cefepime as treatment for osteomyelitis and other severe bacterial infections. J Antimicrob Chemother. 1993;32(suppl B):141-149. doi: 10.1093/jac/32.suppl_b.141 [PubMed 8150758]
Jonckheere S, De Neve N, De Beenhouwer H, et al. A model-based analysis of the predictive performance of different renal function markers for cefepime clearance in the ICU. J Antimicrob Chemother. 2016;71(9):2538-2546. doi:10.1093/jac/dkw171 [PubMed 27246236]
Jones BM, Murray EY, Crosby C, Rojas S, Bland CM. Eosinophilic pneumonia caused by cefepime: a case report and review. IDCases. 2021;25:e01166. doi:10.1016/j.idcr.2021.e01166 [PubMed 34094864]
Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. Published online July 14, 2016. doi:10.1093/cid/ciw353 [PubMed 27418577]
Kanj SS, Sexton DJ. Pseudomonas aeruginosa bacteremia and endocarditis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 9, 2023a.
Kanj SS, Sexton DJ. Pseudomonas aeruginosa skin and soft tissue infections. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 9, 2023b.
Khorasani-Zadeh A, Greca I, Gada K. Cefepime-induced seizures: the overlooked outpatient adverse reaction. Cureus. 2020;12(7):e9268. doi:10.7759/cureus.9268 [PubMed 32699729]
Kim A, Kuti JL, Nicolau DP. Probability of pharmacodynamic target attainment with standard and prolonged-infusion antibiotic regimens for empiric therapy in adults with hospital-acquired pneumonia. Clin Ther. 2009;31(11):2765-2778. doi:10.1016/j.clinthera.2009.11.026 [PubMed 20110018]
Kim A, Kim JE, Paek YM, et al. Cefepime-induced non-convulsive status epilepticus (NCSE). J Epilepsy Res. 2013;3(1):39-41. doi:10.14581/jer.13008 [PubMed 24649471]
Klompas M. Treatment of hospital-acquired and ventilator-associated pneumonia in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 15, 2023.
Knoderer CA, Kaylor DM, Toth ME, Malloy KM, Nichols KR. Characterization of the clinical outcomes with cefepime in a neonatal intensive care unit: a retrospective cohort study. J Pediatr Pharmacol Ther. 2018;23(3):209‐214. doi:10.5863/1551-6776-23.3.209 [PubMed 29970977]
Koomanachai P, Bulik CC, Kuti JL, Nicolau DP. Pharmacodynamic modeling of intravenous antibiotics against gram-negative bacteria collected in the United States. Clin Ther. 2010;32(4):766-779. doi:10.1016/j.clinthera.2010.04.003 [PubMed 20435246]
Kuti JL, Nicolau DP. Optimal cefepime and meropenem dosing for ventilator-associated pneumonia patients with reduced renal function: an update to our clinical pathway. J Crit Care. 2010;25(1):155-156. doi:10.1016/j.jcrc.2010.01.001 [PubMed 20189057]
Lamoth F, Buclin T, Pascual A, et al. High cefepime plasma concentrations and neurological toxicity in febrile neutropenic patients with mild impairment of renal function. Antimicrob Agents Chemother. 2010;54(10):4360-4367. doi:10.1128/AAC.01595-08 [PubMed 20625153]
Lee JD, Heintz BH, Mosher HJ, Livorsi DJ, Egge JA, Lund BC. Risk of acute kidney injury and Clostridioides difficile infection with piperacillin/tazobactam, cefepime, and meropenem with or without vancomycin. Clin Infect Dis. 2021;73(7):e1579-e1586. doi:10.1093/cid/ciaa1902 [PubMed 33382398]
Lee SH, Kim MH, Lee K, Jo EJ, Park HK. Hypersensitivity pneumonitis caused by cephalosporins with identical R1 side chains. Allergy Asthma Immunol Res. 2015;7(5):518-522. doi:10.4168/aair.2015.7.5.518 [PubMed 25749765]
Lehrnbecher T, Robinson P, Fisher B, et al. Guideline for the management of fever and neutropenia in children with cancer and hematopoietic stem-cell transplantation recipients: 2017 update. J Clin Oncol. 2017;35(18):2082-2094. doi:10.1200/JCO.2016.71.7017 [PubMed 28459614]
Lim PP, Chong CP, Aziz NA. Cefepime-associated thrombocytopenia in a critically ill patient. Int J Clin Pharm. 2011;33(6):902-904. doi:10.1007/s11096-011-9571-5 [PubMed 21986835]
Lima-Rogel V, Medina-Rojas EL, Del Carmen Milán-Segovia R, et al. Population Pharmacokinetics of Cefepime in Neonates With Severe Nosocomial Infections. J Clin Pharm Ther. 2008;33(3):295-306. [PubMed 18452417]
Li PK, Chow KM, Cho Y, et al. ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment. Perit Dial Int. 2022;42(2):110-153. doi:10.1177/08968608221080586 [PubMed 27282851]
Lipsky BA, Berendt AR, Cornia PB, et al; Infectious Diseases Society of America. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012;54(12):e132-e173. doi:10.1093/cid/cis346 [PubMed 22619242]
Lizarraga KJ, Heros DO, Adams D, Lang AE, Kanner AM. Opsoclonus-myoclonus-encephalopathy induced by cefepime. J Neurol Sci. 2019;396:33-35. doi:10.1016/j.jns.2018.10.028 [PubMed 30412900]
Lodise TP, Lomaestro BM, Drusano GL; Society of Infectious Diseases Pharmacists. Application of antimicrobial pharmacodynamic concepts into clinical practice: focus on beta-lactam antibiotics: insights from the Society of Infectious Diseases Pharmacists. Pharmacotherapy. 2006;26(9):1320-1332. doi:10.1592/phco.26.9.1320 [PubMed 16945055]
Maan G, Keitoku K, Kimura N, et al. Cefepime-induced neurotoxicity: systematic review. J Antimicrob Chemother. 2022;77(11):2908-2921. doi:10.1093/jac/dkac271 [PubMed 35971666]
MacVane SH, Kuti JL, Nicolau DP. Clinical pharmacodynamics of antipseudomonal cephalosporins in patients with ventilator-associated pneumonia. Antimicrob Agents Chemother. 2014a;58(3):1359-1364. doi:10.1128/AAC.01463-13 [PubMed 24342637]
MacVane SH, Kuti JL, Nicolau DP. Prolonging β-lactam infusion: a review of the rationale and evidence, and guidance for implementation. Int J Antimicrob Agents. 2014b;43(2):105-113. doi:10.1016/j.ijantimicag.2013.10.021 [PubMed 24359838]
Malhotra K, Fazylov R, Friedman-Jakubovics M. A case-report of drug-induced mixed liver injury resulting from cefepime exposure. J Pharm Pract. 2023;36(1):164-167. doi:10.1177/08971900211015046 [PubMed 34098807]
Malincarne L, Francisci D, Martinelli L, Masini G, Baldelli F. A case of severe cefepime-related neutropenia in a 15-year-old patient. Scand J Infect Dis. 2010;42(2):156-157. doi:10.3109/00365540903380503 [PubMed 19902990]
Malone RS, Fish DN, Abraham E, Teitelbaum I. Pharmacokinetics of cefepime during continuous renal replacement therapy in critically ill patients. Antimicrob Agents Chemother. 2001;45(11):3148-3155. doi:10.1128/AAC.45.11.3148-3155.2001 [PubMed 11600370]
Mancini A, Todd L. Inconsistencies in ISPD peritonitis recommendations: 2016 update on prevention and treatment and the ISPD catheter-related infection recommendations: 2017 update. Perit Dial Int. 2018;38(4):309-310. doi:10.3747/pdi.2018.00026 [PubMed 29987068]
Maan G, Keitoku K, Kimura N, et al. Cefepime-induced neurotoxicity: systematic review. J Antimicrob Chemother. 2022;77(11):2908-2921. doi:10.1093/jac/dkac271 [PubMed 35971666]
Marco-Del Río J, Domingo-Chiva E, Cuesta-Montero P, Valladolid-Walsh A, García-Martínez EM. Cefepime associated with phenytoin induced Stevens-Johnson syndrome. Am J Ther. 2017;24(4):e481-e484. doi:10.1097/MJT.0000000000000520 [PubMed 28692440]
Marsh K, Ahmed N, Decano A, et al. Safety of intravenous push administration of beta-lactams within a healthcare system. Am J Health Syst Pharm. 2020;77(9):701-708. doi:10.1093/ajhp/zxaa044 [PubMed 34278415]
Martínez-Rodríguez JE, Barriga FJ, Santamaria J, et al. Nonconvulsive status epilepticus associated with cephalosporins in patients with renal failure. Am J Med. 2001;111(2):115-119. doi:10.1016/s0002-9343(01)00767-7 [PubMed 11498064]
Maxipime (cefepime) [prescribing information]. Lake Forest, IL: Hospira Inc; August 2021.
Mazuski JE, Tessier JM, May AK, et al. The Surgical Infection Society revised guidelines on the management of intra-abdominal infection. Surg Infect (Larchmt). 2017;18(1):1-76. doi:10.1089/sur.2016.261 [PubMed 28085573]
McDonald LC, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018;66(7):e1-e48. doi:10.1093/cid/cix1085 [PubMed 29462280]
McLaughlin JM, Scott RA, Koenig SL, Mueller SW. Intravenous push cephalosporin antibiotics in the emergency department: a practice improvement project. Adv Emerg Nurs J. 2017;39(4):295-299. doi:10.1097/TME.0000000000000160 [PubMed 29095181]
Medrano-Casique N, Tong HY, Borobia AM, Carcas AJ, Frías J, Ramírez E. Non-chemotherapy-induced agranulocytosis detected by a prospective pharmacovigilance program in a tertiary hospital. Basic Clin Pharmacol Toxicol. 2015;117(6):399-408. doi:10.1111/bcpt.12418 [PubMed 26011581]
Meng L, Mui E, Holubar MK, Deresinski SC. Comprehensive guidance for antibiotic dosing in obese adults. Pharmacotherapy. 2017;37(11):1415-1431. doi:10.1002/phar.2023 [PubMed 28869666]
Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America [published corrections appear in Clin Infect Dis. 2010;50(7):1079; Clin Infect Dis. 2010;50(3):457]. Clin Infect Dis. 2009;49(1):1-45. doi:10.1086/599376 [PubMed 19489710]
Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Resp Crit Care Med. 2019;200(7):e45-e67. doi:10.1164/rccm.201908-1581ST [PubMed 31573350]
Middleton PG, Gade EJ, Aguilera C, et al. ERS/TSANZ Task Force Statement on the management of reproduction and pregnancy in women with airways diseases. Eur Respir J. 2020;55(2):1901208. doi:10.1183/13993003.01208-2019 [PubMed 31699837]
Moehring R, Anderson DJ. Gram-negative bacillary bacteremia in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 9, 2023.
Moehring R, Sarubbi C. Prolonged infusions of beta-lactam antibiotics. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed October 13, 2021.
Molloy L, Nichols K. Infectious diseases pharmacotherapy for children with cystic fibrosis. J Pediatr Health Care. 2015;29(6):565‐580. [PubMed 26498903]
Morales Junior R, Pereira GO, Tiguman GMB, et al. Beta-lactams therapeutic monitoring in septic children-what target are we aiming for? A scoping review. Front Pediatr. 2022;10:777854. doi:10.3389/fped.2022.777854 [PubMed 35359889]
Moreno E, Dávila I, Laffond E, et al. Selective immediate hypersensitivity to cefepime. J Investig Allergol Clin Immunol. 2007;17(1):52-54. [PubMed 17323865]
National Institute for Health and Care Excellence. Drug allergy: diagnosis and management. Published September 3, 2014. Accessed October 2, 2020. https://www.nice.org.uk/guidance/cg183
Nguyen C, Clegg T, Kumar A, Paudel S. Cefepime-induced nonconvulsive status epilepticus in a pediatric patient with normal renal function. Child Neurol Open. 2022;9:2329048X221119575. doi:10.1177/2329048X221119575 [PubMed 35968536]
Nicasio AM, Ariano RE, Zelenitsky SA, et al. Population pharmacokinetics of high-dose, prolonged-infusion cefepime in adult critically ill patients with ventilator-associated pneumonia. Antimicrob Agents Chemother. 2009;53(4):1476-1481. doi: 10.1128/AAC.01141-08. [PubMed 19188394]
Nicasio AM, Eagye KJ, Nicolau DP, Shore E, Palter M, et al. Pharmacodynamic-based clinical pathway for empiric antibiotic choice in patients with ventilator-associated pneumonia. J Crit Care. 2010;25(1):69-77. doi:10.1016/j.jcrc.2009.02.014 [PubMed 19427167]
Nichols KR, Karmire LC, Cox EG, Kays MB, Knoderer CA. Implementing extended-infusion cefepime as standard of care in a children's hospital: a prospective descriptive study. Ann Pharmacother. 2015;49(4):419‐426. [PubMed 25614528]
Ohtaki K, Matsubara K, Fujimaru S, et al. Cefoselis, a beta-lactam antibiotic, easily penetrates the blood-brain barrier and causes seizure independently by glutamate release. J Neural Transm (Vienna). 2004;111(12):1523-1535. doi:10.1007/s00702-004-0177-0 [PubMed 15565489]
O'Mahony D, Cherubini A, Guiteras AR, et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 3. Eur Geriatr Med. 2023;14(4):625-632. doi:10.1007/s41999-023-00777-y [PubMed 37256475]
Orhan F, Odemis E, Yaris N, et al. A case of IgE-mediated hypersensitivity to cefepime. Allergy. 2004;59(2):239-241. doi:10.1046/j.1398-9995.2003.00376.x [PubMed 14763949]
Osmon DR, Berbari EF, Berendt AR, et al; Infectious Diseases Society of America. Diagnosis and management of prosthetic joint infection: clinical practice guideline by the Infectious Diseases Society of America. Clin Infect Dis. 2013;56(1):e1-e25. doi:10.1093/cid/cis803 [PubMed 23223583]
Osmon DR, Tande AJ. Osteomyelitis in adults: treatment. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 10, 2023.
Oyenuga M, Oyenuga A, Rauf A, Balogun O, Singh N. New onset non-convulsive status epilepticus despite cefepime renal dose adjustment. Cureus. 2021;13(1):e12689. doi:10.7759/cureus.12689 [PubMed 33614301]
Ozbek B, Otuk G. Post-antibiotic effect of levofloxacin and tobramycin alone or in combination with cefepime against Pseudomonas aeruginosa. Chemotherapy. 2009;55(6):446-450. doi:10.1159/000265128 [PubMed 19996590]
Ozyuncu O, Nemutlu E, Katlan D, Kir S, Beksac MS. Maternal and fetal blood levels of moxifloxacin, levofloxacin, cefepime and cefoperazone. Int J Antimicrob Agents. 2010;36(2):175‐178. doi:10.1016/j.ijantimicag.2010.03.011 [PubMed 20418070]
Panchaud A, Di Paolo ER, Koutsokera A, et al. Safety of drugs during pregnancy and breastfeeding in cystic fibrosis patients. Respiration. 2016;91(4):333‐348. doi:10.1159/000444088 [PubMed 26942733]
Payne LE, Gagnon DJ, Riker RR, et al. Cefepime-induced neurotoxicity: a systematic review. Crit Care. 2017;21(1):276. doi:10.1186/s13054-017-1856-1 [PubMed 29137682]
Perez KK, Hughes DW, Maxwell PR, Green K, Lewis JS 2nd. Cefepime for gram-negative bacteremia in long-term hemodialysis: a single-center experience. Am J Kidney Dis. 2012; 59(5):740-742. doi:10.1053/j.ajkd.2012.01.012 [PubMed 22440135]
Philpott CD, Droege CA, Droege ME, et al. Pharmacokinetics and pharmacodynamics of extended-infusion cefepime in critically ill patients receiving continuous renal replacement therapy: a prospective, open-label study. Pharmacotherapy. 2019;39(11):1066-1076. doi:10.1002/phar.2332 [PubMed 31549737]
Prescott WA Jr, Gentile AE, Nagel JL, Pettit RS. Continuous-infusion antipseudomonal Beta-lactam therapy in patients with cystic fibrosis. P T. 2011;36(11):723‐763. [PubMed 22346306]
Qadri I, Zeng X, Guo R, Koratala A. Acute interstitial nephritis and DRESS syndrome without eosinophilia associated with cefepime. BMJ Case Rep. 2017;2017:bcr2017221401. doi:10.1136/bcr-2017-221401 [PubMed 28775112]
Raghavendran K. Acute colonic diverticulitis: Triage and inpatient management. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed January 5, 2023.
Ramirez JA, Musher DM, Evans SE, et al. Treatment of community-acquired pneumonia in immunocompromised adults: a consensus statement regarding initial strategies. Chest. 2020;158(5):1896-1911. doi:10.1016/j.chest.2020.05.598 [PubMed 32561442]
Reed MD, Yamashita TS, Knupp CK, Veazey JM Jr, Blumer JL. Pharmacokinetics of intravenously and intramuscularly administered cefepime in infants and children. Antimicrob Agents Chemother. 1997;41(8):1783-1787. doi:10.1128/AAC.41.8.1783 [PubMed 9257761]
Refer to manufacturer's labeling.
Rhodes NJ, Grove ME, Kiel PJ, et al. Population pharmacokinetics of cefepime in febrile neutropenia: implications for dose-dependent susceptibility and contemporary dosing regimens. Int J Antimicrob Agents. 2017;50(3):482-486. doi:10.1016/j.ijantimicag.2017.04.008 [PubMed 28668694]
Rhoney DH, Tam VH, Parker D Jr, McKinnon PS, Coplin WM. Disposition of cefepime in the central nervous system of patients with external ventricular drains. Pharmacotherapy. 2003;23(3):310-314. doi:10.1592/phco.23.3.310.32108 [PubMed 12627928]
Rich BS, Keel R, Ho VP, et al. Cefepime dosing in the morbidly obese patient population. Obes Surg. 2012;22(3):465-471. doi:10.1007/s11695-011-0586-8 [PubMed 22249886]
Roberts JA. Beta-lactam therapeutic drug monitoring in the critically ill children: big solution for infections in small people?. Crit Care Med. 2018;46(2):335-337. doi:10.1097/CCM.0000000000002862 [PubMed 29337797]
Roberts JA, Paul SK, Akova M, et al; DALI Study. DALI: defining antibiotic levels in intensive care unit patients: are current β-lactam antibiotic doses sufficient for critically ill patients? Clin Infect Dis. 2014;58(8):1072-1083. doi:10.1093/cid/ciu027 [PubMed 24429437]
Romano A, Gaeta F, Valluzzi RL, et al. IgE-mediated hypersensitivity to cephalosporins: cross-reactivity and tolerability of alternative cephalosporins. J Allergy Clin Immunol. 2015;136(3):685-691.e3. doi:10.1016/j.jaci.2015.03.012 [PubMed 25930196]
Romano A, Gaeta F, Valluzzi RL, Maggioletti M, Caruso C, Quaratino D. Cross-reactivity and tolerability of aztreonam and cephalosporins in subjects with a T cell-mediated hypersensitivity to penicillins. J Allergy Clin Immunol. 2016;138(1):179-186. doi:10.1016/j.jaci.2016.01.025 [PubMed 27016799]
Romano A, Valluzzi RL, Caruso C, Maggioletti M, Quaratino D, Gaeta F. Cross-reactivity and tolerability of cephalosporins in patients with IgE-mediated hypersensitivity to penicillins. J Allergy Clin Immunol Pract. 2018;6(5):1662-1672. doi:10.1016/j.jaip.2018.01.020 [PubMed 29408440]
Roos JF, Bulitta J, Lipman J, Kirkpatrick CM. Pharmacokinetic-pharmacodynamic rationale for cefepime dosing regimens in intensive care units. J Antimicrob Chemother. 2006;58(5):987-993. doi:10.1093/jac/dkl349 [PubMed 16943209]
Sáez-Llorens X, Castaño E, García R, et al. Prospective randomized comparison of cefepime and cefotaxime for treatment of bacterial meningitis in infants and children. Antimicrob Agents Chemother. 1995;39(4):937‐940. doi:10.1128/AAC.39.4.937 [PubMed 7785999]
Sáez-Llorens X, O'Ryan M. Cefepime in the empiric treatment of meningitis in children. Pediatr Infect Dis J. 2001;20(3):356‐361. [PubMed 11303850]
Santibañez M, Bunnell K, Harrington A, Bleasdale S, Wenzler E. Association between estimated pharmacokinetic/pharmacodynamic predictions of efficacy and observed clinical outcomes in obese and nonobese patients with Enterobacteriaceae bloodstream infections. Open Forum Infect Dis. 2019;6(10):ofz400. doi:10.1093/ofid/ofz400 [PubMed 31660362]
Sartelli M, Catena F, Abu-Zidan FM, et al. Management of intra-abdominal infections: recommendations by the WSES 2016 consensus conference. World J Emerg Surg. Published online May 4, 2017. doi:10.1186/s13017-017-0132-7 [PubMed 28484510]
Sawyer RG, Claridge JA, Nathens AB, et al; STOP-IT Trial Investigators. Trial of short-course antimicrobial therapy for intraabdominal infection. N Engl J Med. 2015;372(21):1996-2005. doi:10.1056/NEJMoa1411162 [PubMed 25992746]
Schmaldienst S, Traunmüller F, Burgmann H, et al. Multiple-dose pharmacokinetics of cefepime in long-term hemodialysis with high-flux membranes. Eur J Clin Pharmacol. 2000;56(1):61-64. doi: 10.1007/s002280050721. [PubMed 10853879]
Schrank JH Jr, Kelly JW, McAllister CK. Randomized comparison of cefepime and ceftazidime for treatment of hospitalized patients with gram-negative bacteremia. Clin Infect Dis. 1995;20(1):56-58. doi:10.1093/clinids/20.1.56 [PubMed 7727671]
Sexton DJ, Sampson JH. Intracranial epidural abscess. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed September 16, 2021.
Sexton DJ, Sampson JH. Spinal epidural abscess. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 10, 2023.
Shah KJ, Cherabuddi K, Pressly KB, Wright KL, Shukla A. Clostridioides difficile associated peritonitis in peritoneal dialysis patients - a case series based review of an under-recognized entity with therapeutic challenges. BMC Nephrol. 2020;21(1):76. doi:10.1186/s12882-020-01734-8 [PubMed 32131755]
Shah S, Bland S. Cefepime-induced encephalopathy with seizures in a pediatric patient with end-stage renal disease rapidly reversed by high-efficiency hemodialysis. Cureus. 2021;13(3):e13842. doi:10.7759/cureus.13842 [PubMed 33717772]
Shane AL, Mody RK, Crump JA, et al. 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea. Clin Infect Dis. 2017;65(12):e45-e80. doi:10.1093/cid/cix669 [PubMed 29053792]
Shaw AR, Chaijamorn W, Mueller BA. We underdose antibiotics in patients on CRRT. Semin Dial. 2016;29(4):278-280. doi:10.1111/sdi.12496 [PubMed 27082510]
Shoji K, Bradley JS, Reed MD, van den Anker JN, Domonoske C, Capparelli EV. Population pharmacokinetic assessment and pharmacodynamic implications of pediatric cefepime dosing for susceptible-dose-dependent organisms. Antimicrob Agents Chemother. 2016;60(4):2150‐2156. [PubMed 26810655]
Silva AMPSD, Barbosa LC, Marques LMA, et al. A case-control study of Clostridioides difficile symptomatic infections in a pediatric cancer hospital. Rev Paul Pediatr. 2023;41:e2022117. doi:10.1590/1984-0462/2023/41/2022117 [PubMed 36921180]
Simon RH. Cystic fibrosis: Management of pulmonary exacerbations. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 9, 2023.
So W, Kuti JL, Shepard A, Nugent J, Nicolau DP. Tissue penetration and exposure of cefepime in patients with diabetic foot infections. Int J Antimicrob Agents. 2016;47(3):247-248. doi:10.1016/j.ijantimicag.2016.01.002 [PubMed 26897754]
Solomkin JS, Mazuski JE, Bradley JS, et al. Diagnosis and management of complicated intra-abdominal infections in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America [published correction appears in Clin Infect Dis. 2010; 50(12):1695]. Clin Infect Dis. 2010;50(2):133-164. doi:10.1086/649554 [PubMed 20034345]
Sonck J, Laureys G, Verbeelen D. The neurotoxicity and safety of treatment with cefepime in patients with renal failure. Nephrol Dial Transplant. 2008;23(3):966-970. doi:10.1093/ndt/gfm713 [PubMed 18175786]
Southwick FS. Treatment and prognosis of bacterial brain abscess. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed June 22, 2022.
Spencer S, Ipema H, Hartke P, et al. Intravenous push administration of antibiotics: literature and considerations. Hosp Pharm. 2018;53(3):157-169. doi:10.1177/0018578718760257 [PubMed 30147136]
Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014;59(2):147-59. doi:10.1093/cid/ciu296 [PubMed 24947530]
Stevens V, Dumyati G, Fine LS, Fisher SG, van Wijngaarden E. Cumulative antibiotic exposures over time and the risk of Clostridium difficile infection. Clin Infect Dis. 2011;53(1):42-48. doi:10.1093/cid/cir301 [PubMed 21653301]
Stitt G, Morris J, Schmees L, Angelo J, Akcan Arikan A. Cefepime pharmacokinetics in critically ill pediatric patients receiving continuous renal replacement therapy. Antimicrob Agents Chemother. 2019;63(4):e02006-18. doi:10.1128/AAC.02006-18 [PubMed 30718247]
Subedi A, Songmen S, Manchala V, Mattana J. Cefepime-induced neurotoxicity: an underappreciated cause of encephalopathy. Am J Ther. 2019;26(4):e547-e548. doi:10.1097/MJT.0000000000000801 [PubMed 29905577]
Sugimoto M, Uchida I, Mashimo T, et al. Evidence for the involvement of GABA(A) receptor blockade in convulsions induced by cephalosporins. Neuropharmacology. 2003;45(3):304-314. doi:10.1016/s0028-3908(03)00188-6 [PubMed 12871648]
Sullins AK, Abdel-Rahman SM. Pharmacokinetics of antibacterial agents in the CSF of children and adolescents. Paediatr Drugs. 2013;15(2):93‐117 [PubMed 23529866]
Su TY, Ye JJ, Yang CC, Huang CT, Chia JH, Lee MH. Influence of borderline cefepime MIC on the outcome of cefepime-susceptible Pseudomonas aeruginosa bacteremia treated with a maximal cefepime dose: a hospital-based retrospective study. Ann Clin Microbiol Antimicrob. 2017;16(1):52. doi:10.1186/s12941-017-0227-8 [PubMed 28738848]
Szeto CC, Li PK. Concerns regarding inconsistencies within and between ISPD recommendations for peritonitis and catheter related infections-in reply. Perit Dial Int. 2018;38(4):311-312. doi:10.3747/pdi.2018.00046 [PubMed 29987069]
Tam VH, McKinnon PS, Akins RL, Drusano GL, Rybak MJ. Pharmacokinetics and pharmacodynamics of cefepime in patients with various degrees of renal function. Antimicrob Agents Chemother. 2003;47(6):1853-1861. doi:10.1128/aac.47.6.1853-1861.2003 [PubMed 12760858]
Tamma PD, Aitken SL, Bonomo RA, Mathers AJ, van Duin D, Clancy CJ. Infectious Diseases Society of America 2023 guidance on the treatment of antimicrobial resistant gram-negative infections. Clin Infect Dis. Published online July 18, 2023. doi:10.1093/cid/ciad428 [PubMed 37463564]
Thabit AK, Varugehese CA, Levine AR. Antibiotic use and duration in association with Clostridioides difficile infection in a tertiary academic medical center: a retrospective case-control study. Anaerobe. 2019;59:126-130. doi:10.1016/j.anaerobe.2019.06.016 [PubMed 31254655]
Thompson RZ, Martin CA, Burgess DR, Rutter WC, Burgess DS. Optimizing beta-lactam pharmacodynamics against Pseudomonas aeruginosa in adult cystic fibrosis patients. J Cyst Fibros. 2016;15(5):660-663. doi:10.1016/j.jcf.2016.04.002 [PubMed 27132188]
Tran A, O'Sullivan D, Krawczynski M. Cefepime intravenous push versus intravenous piggyback on time to administration of first-dose vancomycin in the emergency department. J Pharm Pract. 2018;31(6):605-609. doi:10.1177/0897190017734442 [PubMed 29046121]
Triplett JD, Lawn ND, Chan J, Dunne JW. Cephalosporin-related neurotoxicity: metabolic encephalopathy or non-convulsive status epilepticus?. J Clin Neurosci. 2019;67:163-166. doi:10.1016/j.jocn.2019.05.035 [PubMed 31201049]
Trotman RL, Williamson JC, Shoemaker DM, Salzer WL. Antibiotic dosing in critically ill adult patients receiving continuous renal replacement therapy. Clin Infect Dis. 2005;41(8):1159-1166. [PubMed 16163635]
Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;39(9):1267-1284. doi:10.1086/425368 [PubMed 15494903]
Tunkel AR, Hasbun R, Bhimraj A, et al. 2017 Infectious Diseases Society of America's clinical practice guidelines for healthcare-associated ventriculitis and meningitis. Clin Infect Dis. Published online February 14, 2017. doi:10.1093/cid/ciw861 [PubMed 28203777]
Vardakas KZ, Trigkidis KK, Boukouvala E, Falagas ME. Clostridium difficile infection following systemic antibiotic administration in randomised controlled trials: a systematic review and meta-analysis. Int J Antimicrob Agents. 2016;48(1):1-10. doi:10.1016/j.ijantimicag.2016.03.008 [PubMed 27216385]
Veltri MA, Neu AM, Fivush BA, Parekh RS, Furth SL. Drug dosing during intermittent hemodialysis and continuous renal replacement therapy: special considerations in pediatric patients. Paediatr Drugs. 2004;6(1):45-65. [PubMed 14969569]
Vermont Oxford Network (VON). Neonatal drug concentrations. Updated November 2022. Accessed August 10, 2023. https://public.vtoxford.org/neonatal-drug-concentrations
Vollmer CM Jr, Zakko SF, Afdhal NH. Treatment of acute calculous cholecystitis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed April 13, 2023.
Warady BA, Bakkaloglu S, Newland J, et al. Consensus guidelines for the prevention and treatment of catheter-related infections and peritonitis in pediatric patients receiving peritoneal dialysis: 2012 update. Perit Dial Int. 2012;(32)(suppl 2):S32-S86. [PubMed 22851742]
Watson T, Hickok J, Fraker S, Korwek K, Poland RE, Septimus E. Evaluating the risk factors for hospital-onset Clostridium difficile infections in a large healthcare system. Clin Infect Dis. 2018;66(12):1957-1959. doi:10.1093/cid/cix1112 [PubMed 29272341]
Weintrob AC, Sexton DJ. Clinical manifestations, diagnosis, and management of diabetic infections of the lower extremities. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 9, 2023.
World Health Organization (WHO). Breastfeeding and maternal medication, recommendations for drugs in the eleventh WHO model list of essential drugs. http://www.who.int/maternal_child_adolescent/documents/55732/en. Published 2002.
Wingard JR. Treatment of neutropenic fever syndromes in adults with hematologic malignancies and hematopoietic cell transplant recipients (high-risk patients). Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 10, 2023.
Wong Kee Song LM, Marcon NE. Neutropenic enterocolitis (typhlitis). Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 10, 2023.
Wrenn RH, Cluck D, Kennedy L, Williamson JC. Extended infusion compared to standard infusion cefepime as empiric treatment of febrile neutropenia. J Oncol Pharm Pract. 2018;24(3):170-175. doi:10.1177/1078155216687151 [PubMed 28077047]
Wynd MA, Paladino JA. Cefepime: A Fourth-Generation Parenteral Cephalosporin. Ann Pharmacother. 1996;30(12):1414-1424. [PubMed 8968455]
Yahav D, Franceschini E, Koppel F, et al; Bacteremia Duration Study Group. Seven versus fourteen days of antibiotic therapy for uncomplicated gram-negative bacteremia: a non-inferiority randomized controlled trial. Clin Infect Dis. 2019;69(7):1091-1098. doi:10.1093/cid/ciy1054 [PubMed 30535100]
Yang K, Moga T, Nallapeta NS, et al. Severe cholestatic drug-induced liver injury with cephalosporin use. Cureus. 2022;14(12):e32262. doi:10.7759/cureus.32262 [PubMed 36620795]
Zasowski E, Bland CM, Tam VH, Lodise TP. Identification of optimal renal dosage adjustments for high-dose extended-infusion cefepime dosing regimens in hospitalized patients. J Antimicrob Chemother. 2015;70(3):877-881. doi:10.1093/jac/dku435 [PubMed 25381169]
Zhao Y, Yao BF, Kou C, et al. Developmental population pharmacokinetics and dosing optimization of cefepime in neonates and young infants. Front Pharmacol. 2020;11:14. doi: 10.3389/fphar.2020.00014 [PubMed 32116695]
Zobell JT, Waters CD, Young DC, et al. Optimization of anti-pseudomonal antibiotics for cystic fibrosis pulmonary exacerbations: II. cephalosporins and penicillins. Pediatr Pulmonol. 2013;48(2):107-122. doi:10.1002/ppul.22669 [PubMed 22949297]
Zuppa AF, Zane NR, Moorthy G, et al. A population pharmacokinetic analysis to study the effect of extracorporeal membrane oxygenation on cefepime disposition in children. Pediatr Crit Care Med. 2019;20(1):62-70. doi:10.1097/PCC.0000000000001786 [PubMed 30431557]

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Cefepime: Drug information