Cefepime is a fourth-generation cephalosporin antibiotic. Cefepime has an extended spectrum of activity against Gram-positive and Gram-negative bacteria, with greater activity against both types of organism than third-generation agents. A 2007 meta-analysis suggested when data of trials were combined, Mortality rate was increased in people treated with cefepime compared with other β-lactam antibiotics.
Cefepime was patented in 1982 by Bristol-Myers Squibb and approved for medical use in 1994.
It was removed from the World Health Organization's List of Essential Medicines in 2019.
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 , 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
GABA (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,
Seizure, 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
beta 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.
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