Cefepime

Medical use

Cefepime is usually reserved to treat moderate to severe nosocomial pneumonia, infections caused by multiple drug-resistant microorganisms (e.g. Pseudomonas aeruginosa) and empirical treatment of febrile neutropenia.

Cefepime has good activity against important pathogens including Pseudomonas aeruginosa, Staphylococcus aureus, and multiple drug-resistant Streptococcus pneumoniae. A particular strength is its activity against Enterobacteriaceae. Whereas other cephalosporins are degraded by many plasmid- and chromosome-mediated beta-lactamases, cefepime is stable and is a front-line agent when infection with Enterobacteriaceae is known or suspected.

Spectrum of bacterial susceptibility

Cefepime is a broad-spectrum cephalosporin antibiotic and has been used to treat bacteria responsible for causing pneumonia and infections of the skin and urinary tract. Some of these bacteria include Pseudomonas, Escherichia, and Streptococcus species. The following represents MIC susceptibility data for a few medically significant microorganisms:

• Escherichia coli: ≤0.007 – 128 μg/ml
• Pseudomonas aeruginosa: 0.06 – 256 μg/ml
• Streptococcus pneumoniae: ≤0.007 – 8 μg/ml

Cefepime induced neurotoxicity

Cefepime crosses the blood brain barrier and exhibits a concentration-dependent ϒ-aminobutyric acid (GABA) antagonist effect, which can cause neurological symptoms in susceptible individuals, particularly those with renal dysfunction. Up to 15% of ICU patients treated with cefepime will experience cefepime induced neurotoxicity. Symptoms typically begin within 2-6 days of cefepime administration and include diminished level of consciousness, disorientation, aphasia, myoclonus, seizures, and nonconvulsive status epilepticus. Symptoms typically resolve within 1-3 days of discontinuing cefepime.

Chemistry

The combination of the syn-configuration of the methoxy imino moiety and the aminothiazole moiety confers extra stability to β-lactamase enzymes produced by many bacteria. The N-methyl pyrrolidine moiety increases penetration into Gram-negative bacteria. These factors increase the activity of cefepime against otherwise resistant organisms including Pseudomonas aeruginosa and Staphylococcus aureus.

Trade names

Following expiration of the Bristol-Myers Squibb patent, cefepime became available as a generic and is now marketed by numerous companies worldwide under tradenames including Neopime (Neomed), Maxipime, Cepimax, Cepimex, and Axepim.

References

References

1. (May 2007). "Efficacy and safety of cefepime: a systematic review and meta-analysis". The Lancet. Infectious Diseases.
2. "FDA Alert: Cefepime (marketed as Maxipime)". [[Food and Drug Administration]].
3. (2006). "Analogue-based Drug Discovery". John Wiley & Sons.
4. "Cefepime (maxipime), large spectrum 4th generation cephalosporin, resistant to beta-lactamases].".
5. (2019). "Executive summary: the selection and use of essential medicines 2019: report of the 22nd WHO Expert Committee on the selection and use of essential medicines". World Health Organization.
6. (2003). "Cefepime: a review of its use in the management of hospitalized patients with pneumonia". American Journal of Respiratory Medicine.
7. "Cefepime Susceptibility and Concentration Range (μg/ml) Minimum Inhibitory Concentration (MIC) Data". toku-e.com.
8. (2017). "Characterizing Cefepime Neurotoxicity: A Systematic Review". Open Forum Infectious Diseases.
9. (November 2017). "Cefepime-induced neurotoxicity: a systematic review". Critical Care.
10. (2019-12-24). "Cefepime-induced neurotoxicity". Journal of Neurocritical Care.
11. "Cefepime-induced neurotoxicity".