Cefepime

How it works

It is bactericidal, binding penicillin-binding proteins to inhibit cell-wall synthesis, and is relatively stable to many beta-lactamases, giving broad Gram-negative and Gram-positive cover.

Prescribing in practice

• Doses must be reduced according to renal function, as accumulation in renal impairment is associated with neurotoxicity including encephalopathy, myoclonus and non-convulsive status epilepticus.
• Avoid in patients with a history of immediate or severe hypersensitivity to penicillins or cephalosporins.
• It retains useful activity against Pseudomonas aeruginosa, which informs its place in empirical regimens.

Monitoring

Monitor renal function to guide dosing and watch for new neurological signs such as confusion or myoclonus, particularly in renal impairment.

Counselling the patient

• This antibiotic is given into a vein, with the dose adjusted to your kidney function.
• Tell staff straight away about any confusion, muscle twitching or fits.
• Report any rash, swelling or difficulty breathing.

Evidence & guidelines

The MHRA and SPC highlight the risk of serious neurological reactions with cefepime when doses are not adjusted in renal impairment.