Cefepime
Maxipime
4th-generation cephalosporin
β-lactam cell-wall inhibitor. Broad gram-negative (incl. Pseudomonas) + gram-positive coverage.
Indications
- •Nosocomial/pseudomonal infections
- •Febrile neutropenia
- •Complicated intra-abdominal/UTI
Dosing
| Context | Adult | Pediatric |
|---|---|---|
| Serious infection | 1–2 g IV q8–12h (renally adjusted) | — |
Pharmacokinetics
Half-life ~2 h. Renally cleared — accumulation → neurotoxicity.
Side effects
- !CEFEPIME NEUROTOXICITY (encephalopathy, myoclonus, nonconvulsive status — esp. renal failure/underdosed adjustment)
- !C. difficile
- !Allergy
Contraindications
- ×Severe cephalosporin allergy
- ×Renal impairment without dose adjustment
Clinical pearls
- ★Watch for cefepime neurotoxicity in renal impairment — altered mental status/myoclonus that's easy to miss.
- ★Antipseudomonal — a common ICU/neutropenic-fever cephalosporin.
Other drugs in Antibiotics
- Cefazolin
β-lactam — inhibits bacterial cell wall PBPs.
- Vancomycin
Inhibits cell wall synthesis (binds D-Ala-D-Ala). Active against MRSA + gram-positives.
- Clindamycin
Binds 50S ribosomal subunit, blocks peptide-bond formation. Bacteriostatic against most organisms; bactericidal against susceptible streptococci. Excellent activity against anaerobes and gram-positive cocci including community-acquired MRSA.
- Gentamicin
Binds 30S ribosomal subunit, causes misreading of mRNA → defective bacterial protein synthesis. Bactericidal, concentration-dependent killing. Synergy with cell-wall agents (β-lactams, vancomycin) for gram-positive endocarditis.
- Cefuroxime
β-lactam — inhibits cell-wall synthesis (PBP binding). 2nd-gen: gram-positive + expanded gram-negative.
- Cefotetan
β-lactam; adds anaerobic (B. fragilis) coverage → colorectal/gynecologic prophylaxis.
- Cefotaxime
β-lactam cell-wall inhibitor. Broad gram-negative + CNS penetration.
- Cefoxitin
β-lactam with anaerobic (B. fragilis) activity → colorectal/GYN prophylaxis.
Browse all classes: /reference/drugs
Suggested reading
- •Miller's Anesthesia, 9e
- •FDA package insert
