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Microbiology: Cefepime is a bactericidal agent that acts by inhibition of bacterial cell wall synthesis. It has a spectrum of activity against a range of gram-positive and gram-negative bacteria. Cefepime is highly resistant to hydrolysis by a number of β-lactamases, has a low affinity for chromosomally encoded β-lactamases and exhibits rapid penetration into gram-negative bacterial cells.
Cefepime has been shown to be active against most strains tested of the following organisms both in vitro and in clinical infections.
Gram-Negative Aerobes: Acinetobacter calcoaceticus (subsp anitratus, lwoffi); Enterobacter spp (including E. aerogenes, E. agglomerans, E. cloacae, E. sakazakii), Escherichia coli; Haemophilus influenzae (including strains of β-lactamase-producing H. influenzae); Haemophilus parainfluenzae; Klebsiella spp (including K. oxytoca, K. ozaenae, K. pneumoniae); Moraxella catarrhalis (formerly Branhamella catarrhalis); Morganella morganii; Proteus mirabilis; Pseudomonas aeruginosa; Serratia marcescens.
Cefepime exhibits in vitro minimum inhibitory concentrations (MICs) of ≤8 mcg/mL against ≥90% of the strains of the following microorganisms; however, in vitro activity does not necessarily imply clinical efficacy.
Gram-Positive Aerobes: Staphylococcus aureus (including β-lactamase-producing strains but excluding methicillin-resistant staphylococci), Staphylococcus epidermidis (including β-lactamase-producing strains), Staphylococcus hominis, Staphylococcus saprophyticus, Group D streptococci (Streptococcus bovis), Viridans streptococci.
Anaerobes: Clostridium perfringens, Mobiluncus sp.
Pharmacokinetics: The average plasma concentration of cefepime observed in healthy adult male volunteers at various times following single 30-min infusion (IV) of cefepime 500 mg, 1 g and 2 g are summarized in Table 1. Elimination of cefepime is principally via renal excretion with an average (±SD) t½ of 2±0.3 hrs.
There is no evidence of accumulation. The protein-binding of cefepime in blood is approximately 20% and is independent of its concentration in serum. Cefepime is excreted unchanged in urine which accounts for approximately 85% of the administered dose. (See Tables 1 and 2.)
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