Cefepime is a fourth-generation cephalosporin antibiotic used to treat various severe bacterial infections. It demonstrates broad-spectrum antimicrobial activity against both gram-positive and gram-negative organisms, making it particularly valuable in treating serious infections.
Generic names: Cefepime
Brand names: Maxipime, Cefomax, Neopime
Pharmacologic class: Fourth-generation cephalosporin antibiotic
Therapeutic class: Anti-infective, antibiotic
Mechanism of action: Cefepime works by inhibiting bacterial cell wall synthesis. It binds to penicillin-binding proteins (PBPs), leading to the disruption of bacterial cell wall formation and ultimately causing bacterial cell death.
Indications for use: Treatment of moderate to severe bacterial infections including:
- Pneumonia (hospital-acquired and community-acquired)
- Urinary tract infections (complicated and uncomplicated)
- Skin and soft tissue infections
- Intra-abdominal infections
- Septicemia
- Febrile neutropenia
Precautions and contraindications: Known hypersensitivity to cefepime or other cephalosporins. Use with caution in patients with:
- History of penicillin allergy
- Renal impairment
- Seizure disorders
- Pregnancy (Category B)
- Breastfeeding mothers
- Elderly patients
Drug Interactions
- Probenecid increases cefepime levels by decreasing renal excretion
- Live bacterial vaccines may be less effective
- Aminoglycosides may increase the risk of nephrotoxicity
- Loop diuretics may increase the risk of ototoxicity
- Oral anticoagulants may have increased effects
Adverse Effects
- Gastrointestinal disturbances (diarrhea, nausea, vomiting)
- Headache and dizziness
- Rash and pruritus
- Fever and chills
- Pseudomembranous colitis
- Neutropenia and thrombocytopenia
- Seizures (particularly in patients with renal impairment)
- Injection site reactions
- Superinfection (particularly with Candida)
Administration Considerations
Available preparations: Powder for injection (1g, 2g vials)
Dosages:
- Adults: 1-2g IV every 8-12 hours, depending on infection severity
- Pediatric: 50 mg/kg every 8-12 hours
- Dosing adjustments required for renal impairment
Administration timing:
- IV push: Over 3-5 minutes
- IV infusion: Over 30 minutes
- Onset: Immediate
- Peak: 30 minutes after completion of infusion
- Duration: 8-12 hours
Nursing Considerations for Cefepime
Related Nursing Diagnoses
- Risk for infection related to therapeutic immunosuppression
- Deficient knowledge related to medication regimen
- Risk for adverse reaction related to antibiotic therapy
- Risk for fluid volume deficit related to diarrhea
- Risk for altered body temperature
Nursing Assessment
Perform thorough assessment of allergies, particularly to penicillins and cephalosporins
Obtain complete health history including:
- Current infection symptoms
- Previous antibiotic use
- Kidney function
- Seizure history
- Gastrointestinal disorders
Monitor vital signs, particularly temperature, before and during therapy
Assess injection sites for signs of phlebitis or infiltration
Monitor intake and output, particularly in patients with renal impairment
Nursing Interventions
- Administer medication at scheduled intervals to maintain therapeutic blood levels.
- Monitor CBC, renal function tests, and hepatic function tests
- Observe for signs of superinfection or C. difficile infection
- Ensure proper reconstitution and administration of medication
- Monitor neurological status, particularly in patients with renal impairment
- Document response to therapy, including temperature trends and culture results
Patient Teaching Associated with Cefepime
Explain the importance of completing the entire course of antibiotics, even if symptoms improve
Instruct patients to report any signs of allergic reaction immediately:
- Rash
- Itching
- Difficulty breathing
- Swelling of face or throat
Advise patients to report severe diarrhea, which could indicate C. difficile infection.
Educate about proper hydration during therapy.
Inform patients about possible side effects and when to seek medical attention
Discuss the importance of notifying healthcare providers about:
- All current medications
- Pregnancy or breastfeeding status
- History of seizures
- Kidney problems
This is not an all-inclusive list of possible drug interactions, adverse effects, precautions, nursing considerations, or patient instructions. Please consult further with a pharmacist for complete information.
References and Sources
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Bc, J. B. D. A., Rosenthal, L., & Yeager, J. J. (2021). Study Guide for Lehne’s Pharmacology for Nursing Care. Saunders.
- Chapuis, T. M., Giannoni, E., Majcherczyk, P. A., et al. (2022). Prospective monitoring of cefepime in intensive care unit adult patients. Critical Care, 24(1), 558.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Lidén, M. M., Von Dach, E., Masouridi-Levrat, S., Chalandon, Y., Lescuyer, P., Tonoli, D., Neofytos, D., & Huttner, A. (2024). Cefepime trough levels and clinical outcomes in patients undergoing universal therapeutic drug monitoring: A prospective cohort study. CMI Communications, 1(2), 100011. https://doi.org/10.1016/j.cmicom.2024.100011
- Pais GM, Chang J, Barreto EF, Stitt G, Downes KJ, Alshaer MH, Lesnicki E, Panchal V, Bruzzone M, Bumanglag AV, Burke SN, Scheetz MH. Clinical Pharmacokinetics and Pharmacodynamics of Cefepime. Clin Pharmacokinet. 2022 Jul;61(7):929-953. doi: 10.1007/s40262-022-01137-y. Epub 2022 Jun 29. PMID: 35764774; PMCID: PMC9345683.
- Vardakas, K. Z., Voulgaris, G. L., Maliaros, A., et al. (2023). Prolonged infusion versus intermittent bolus of beta-lactams for patients with sepsis: a systematic review and meta-analysis. The Lancet Infectious Diseases, 18(4), 487-496.
- Wagenlehner FM, Gasink LB, McGovern PC, Moeck G, McLeroth P, Dorr M, Dane A, Henkel T; CERTAIN-1 Study Team. Cefepime-Taniborbactam in Complicated Urinary Tract Infection. N Engl J Med. 2024 Feb 15;390(7):611-622. doi: 10.1056/NEJMoa2304748. PMID: 38354140.
