Cefepime
Class
Cephalosporin (4th gen)
Dose
2g IV q8h (usual starting dose)
1g IV q8h (stepdown for most non pseudomonal infections)
Mechanism
Bactericidal
MoA
Inhibits cell wall (peptidoglycan) synthesis
Mimics D-Ala-D-Ala (substrate required for cell wall synthesis)
Transpeptidases instead bind to b-lactam nucleus
Time v Concentration
Time
Post dose effect
Short
Spectrum
Covers
Doesn't Cover
Good G –ve: Pseudomonas, Enterobacter, E Coli, Hemophilus influenza, Klebsiella
G +ve: Staph aureus, streptococci
Enterococcus, Anaerobes, Atypicals
Indications
Nosocomal Pneumonia
Febrile neutropenia
Renal Tract Infections
Skin infections
Intra-abdominal (+ Metronidazole)
PK
A
Good IM absorption
D
PPB 18%
Vd 18L
M
Minimal hepatic metabolism
E
>80% excreted in kidneys unchanged
T1/2b 2hrs
A/E
NEURO: Seizures, Non convulsive status, Encephalopathy, Neuromuscular excitability
Resistance
Can evolve on therapy
Monitoring
Renal fn