Cefepime

Cefepime (INN) (pronounced /ˈsɛfəpiːm/, /ˈkɛfəpiːm/) is a fourth-generation cephalosporin antibiotic developed in 1994. Cefepime has an extended spectrum of activity against Gram-positive and Gram-negative bacteria, with greater activity against both Gram-negative and Gram-positive organisms than third-generation agents. Cefepime hydrochloride was first marketed in 1994 and is currently marketed under various trade names including Maxipime (Elan Pharma), Maxcef, Cepimax, Cepimex, and Axepim. A FDA MedWatch early communication reports an increased risk of death per an article in the May 2007 issue of The Lancet Infectious Diseases (Efficacy and safety of cefepime: a systematic review and meta-analysis).

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Clinical use

Cefepime is usually reserved to treat severe nosocomial pneumonia, infections caused by multi-resistant microorganisms (e.g. Pseudomonas aeruginosa) and empirical treatment of febrile neutropenia.^[1] The use of cefepime might become less common, since it has been associated to an increase mortality when used for different types of infections.

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.

Chemistry

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

References

^  Chapman TM, Perry CM. Cefepime: a review of its use in the management of hospitalized patients with pneumonia. Am JRespir Med. 2003;2(1):75-107. PMID 14720024 ^  Yahav, D et al. Efficacy and safety of cefepime: a systematic review and meta-analysis. Lancet 2007; 7:338-348.

See also

• Cephalosporin