Infectious Disease Compendium

Cefepime (Maxcef®, Maxipime®, Not Maxpads)

Dosing

CrCl Formula

CrCl > 80: 0.5 - 2 gm iv q 8 - 12 h.

Extended infusion (a 4­h infusion of 2 g every 8 h) my increase survival in Pseudomonas aeruginosa (PubMed).

CrCl 80-50: 0.5 - 2 gm iv q 12 - 24 h.

CrCl 50-10: 0.5 - 2 gm iv q 24 h.

CrCl < 10: 250 mg - 500 mg iv q 25 h.

Hemodialysis: 250 mg after dialysis.

Peritoneal dialysis: 1 - 2 gm iv q 48 h.

Important side effects

Encephalopathy, myoclonus, and seizures when you don’t alter dose for CrCl (PubMed).

Obesity dosing

Important drug interactions

Rants and Screeds

Pearls

Turns out that sensitive should be less than 8 ug/ml, not equal to 8 ug/ml (PubMed).

Treatment of choice

Use for

Pseudomonas and Enterobacter are often sensitive to this agent when resistant to all others.

If the organism is an ESBL, DO NOT use cefepime even if susceptible. Won't work as well as carbapenems (PubMed). Remember that sensitive in the lab does not always mean effective in the patient.

Arthritis, Cellulitis, Neutropenic fever, Intra abdominal infections, Meningitis, Osteomyelitis, Peritonitis - dialysis-related, Pneumonia, Pyelonephritis, UTI.

Don't use for

I remain unenthusiastic about using this drug for staph, despite it being a so called 4th generation cephalosporin. It violates the MMPVIIAHTBTM principal.

Class

Fourth generation cephalosporin.