Antibiotic · Beta-lactam · Cephalosporin

Cefepime (Maxipime)

Also called Maxipime

Reviewed by Alex G, BSN, RN, CEN, CCRN, CMC, NREMT-P · From the Reference tab of the app

Indications

Moderate to severe pneumonia, including Pseudomonas (label)
Empiric therapy for febrile neutropenia, 2 g every 8 h (label)
Complicated intra-abdominal infection, with metronidazole (label)
Urinary tract and uncomplicated skin infections (label)
Empiric gram-negative and Pseudomonas coverage in sepsis and hospital-acquired pneumonia; post-neurosurgical meningitis (off-label)

Dosing

Where	Dose
Antimicrobials	Cefepime: Reduce at CrCl 60 or less; neurotoxicity (confusion, myoclonus, nonconvulsive seizures) in AKI

On the quick cards

Penicillins (-cillin) and cephalosporins (cef-, ceph-)NCLEX Drug Classes: Beta-lactam antibiotics

Mechanism of action

Cefepime is a fourth-generation cephalosporin that binds penicillin-binding proteins and blocks cell-wall synthesis (label), so dividing bacteria lyse; killing depends on time above the MIC. Its positively charged N-methylpyrrolidinium group makes it a zwitterion that crosses gram-negative porins quickly and binds chromosomal AmpC beta-lactamases poorly, keeping it active against many AmpC producers. ESBLs and carbapenemases hydrolyze it. In the brain, beta-lactams antagonize GABA-A receptors, the likely basis of its neurotoxicity.

Pharmacology

Infectious: gram-negative rods including Pseudomonas, plus MSSA and streptococci; no activity against MRSA, enterococci or Bacteroides, hence metronidazole for abdominal infection
CNS: encephalopathy, myoclonus, seizures and nonconvulsive status epilepticus, mostly with unadjusted doses in renal impairment (label); fewer delirium- and coma-free days than piperacillin-tazobactam (11.9 vs 12.2 of 14; ACORN 2023)
Renal: stage 3 AKI 7.0% vs 7.5% with piperacillin-tazobactam (ACORN 2023)
Hematologic: positive Coombs test without hemolysis 16.2%; falling prothrombin activity (label)
Skin and local: rash 1.1%, phlebitis 1.3% (label)

Pharmacokinetics

Half-life	About 2 h (label)
Distribution	Vd about 18 L at steady state (label)
Protein binding	About 20% (label)
Metabolism	Minor: under 1% of the dose appears in urine as N-methylpyrrolidine (label)
Elimination	About 85% unchanged in urine (label)
Renal dosing	Adjust at CrCl 60 mL/min or less (label)
Dialysis	A 3-h session removes about 68%; 1 g on day 1, then 500 mg daily for most infections (label)
Infusion	Over about 30 min (label); extended infusion off-label

Chemistry

Cephalosporin, C₁₉H₂₄N₆O₅S₂ for the cefepime moiety (label), with an aminothiazolyl methoxyimino side chain at C-7 and a quaternary N-methylpyrrolidinium at C-3
Supplied as cefepime hydrochloride mixed with L-arginine, which sets the reconstituted pH at 4–6 (label)

Adverse effects and cautions

In the one-pagers

Sepsis and Septic Shock BundleHour-1 bundle element by element: Underfilled bottles are the commonest cause of false-negative cultures. Give the beta-lactam first: cefepime and meropenem can be pushed over 3–5 min where policy allows, while vancomycin runs 1–2 h. Loading doses are full regardless of renal function because sepsis expands the volume of distribution. Epinephrine, metformin, liver failure and seizures raise lactat

Practice Sepsis and Septic Shock Bundle questions free5 exam-style questions with rationales on the topic where Cefepime comes up most. No account or download needed.

In the algorithms

New Confusion or Agitation

Practice free in your browser2,150+ exam-style questions with rationales. No account, no ads. Also free on the App Store and Google Play.

Sources

FDA label: Cefepime for Injection (Hospira, 2024)
Qian 2023 (ACORN trial)

For education and exam preparation only. Follow your institution’s protocols. Typical adult values for study. Follow the order, the label and your institution's protocols.