Cefepime with enmetazobactam

How it works

Cefepime inhibits cell-wall synthesis by binding penicillin-binding proteins, while enmetazobactam, a penicillanic acid sulfone inhibitor, neutralises extended-spectrum beta-lactamases and restores cefepime activity against many ESBL-producing Enterobacterales.

Prescribing in practice

• Reserve for serious Gram-negative infection under specialist guidance to limit resistance, and avoid in patients with severe cephalosporin or beta-lactam hypersensitivity.
• Cefepime is associated with dose-related neurotoxicity, including encephalopathy, myoclonus and non-convulsive status epilepticus, particularly in renal impairment, so renal dose adjustment is essential.
• Both components are renally eliminated and require dose modification in renal impairment.

Monitoring

Monitor renal function, neurological status for signs of cefepime encephalopathy, and microbiological response.

Counselling the patient

• This is a hospital intravenous antibiotic for serious infections such as kidney infection.
• Report confusion, twitching, or reduced alertness, as well as any rash or breathing difficulty.

Evidence & guidelines

The ALLIUM trial supported its use in complicated urinary tract infection, including pyelonephritis.