Pharm 101: Cefepime

Class

Fourth generation cephalosporin

Pharmacodynamics

• Beta lactam antibiotic
• Inhibits transpeptidation reaction of bacterial cell wall synthesis
• Halts peptidoglycan synthesis, leading to inhibition of bacterial growth, and ultimately cell death (bacteriocidal)
• Beta-lactam antibiotics kill bacterial cells only when they are actively growing and synthesising cell wall

Pharmacokinetics

• Penetrates well into CSF
• Half-life 2 hours
• Renal clearance

Antimicrobial activity

• More resistant to chromosomal B-lactamases (e.g. those produced by Enterobacter)
• Good activity against P aeruginosa, Enterobacter, MSSA, S. pneumoniae
• Highly active against Haemophilus and Neisseria sp.
• Commonly used in empirical treatment of febrile neutropenia

Adverse effects of cephalosporins

• Allergy:
  • Cross-allergenicity between penicillins and cephalosporins is ~1%
• Toxicity:
  • Thrombophlebitis after IVI
  • Renal toxicity: interstitial nephritis, tubular necrosis (rare)
• Methylthiotetrazole-containing agents (cefotetan, cefoperazone) may cause bleeding disorders and disulfiram-like reactions

Precautions/contraindications

• Penicillin anaphylaxis
• Dose reduction in renal failure

Further reading

• Buttner R. Pharm 101: Cephazolin. LITFL
• Buttner R. Pharm 101: Cefuroxime. LITFL
• Buttner R. Pharm 101: Ceftriaxone. LITFL

References

• Katzung BG. Basic and Clinical Pharmacology. 14e. 2018: 802-806, 812