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Fourth-generation cephalosporin Pregnancy: There are no sufficient data on exposure in pregnancy. Animal studies do not indicate direct or indirect harmful effects with respect to pregnancy, embryonal/foetal development, labour or post-natal development. This medicinal product should only be prescribed to pregnant women with great caution. Breastfeeding: cefepime is excreted in human milk in very low quantities, so caution is recommended.

Cefepime

Brand names: Maxipime

Cefepime is an intravenous fourth-generation cephalosporin antibiotic used for serious infections including hospital-acquired pneumonia, complicated urinary tract and intra-abdominal infections and febrile neutropenia.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 500 mg to 2 g per dose, according to the severity of the infection (mild to moderate urinary tract infection 500 mg to 1 g; other mild to moderate non-UTI infections 1 g; severe infections 2 g; very severe or life-threatening infections 2 g)
Route: Intravenous or intramuscular. The IV route is preferable in patients with severe infections or in a life-threatening situation, particularly if there is the possibility of shock
Frequency: Every 12 hours; every 8 hours for very severe or life-threatening infections
Max: 2 g every 8 hours — the maximum recommended dose for adults should not be exceeded
UK SPC (Renapime 1 g powder for solution for injection/infusion), adults and children weighing more than 40 kg with normal renal function. Full table: mild to moderate urinary tract infection 500 mg to 1 g IV or IM every 12 h; other mild to moderate infections (non-UTI) 1 g IV or IM every 12 h; severe infections 2 g IV every 12 h; very severe or life-threatening infections 2 g IV every 8 h. DURATION: usual treatment duration 7 to 10 days; more severe infections can require more prolonged treatment. In the empirical treatment of febrile neutropenia the usual duration should not be less than 7 days or until resolution of the neutropenia. In patients weighing 40 kg or less the posology indicated for children is recommended. ELDERLY: no dose adjustment in normal renal function; adjustment is recommended in impaired renal function. HEPATIC IMPAIRMENT: no dose adjustment required. DIALYSIS: in patients on haemodialysis give 1 g as a loading dose on the first day of treatment followed by 500 mg daily for all infections, except febrile neutropenia which is 1 g daily; on dialysis days administer after dialysis, and give at the same time every day where possible. In continuous ambulatory peritoneal dialysis, cefepime may be given in the doses recommended for normal renal function (500 mg, 1 g or 2 g depending on severity) but with a 48-hour interval between doses.

Paediatric dose

Dose: 50 mg/kg
Route: Intravenous (experience with the intramuscular route in children is limited)
Frequency: Every 12 hours for pneumonia, urinary tract infection and skin/subcutaneous tissue infection (in more severe infections an 8-hour interval should be used); every 8 hours for bacteraemia occurring in association with infections, bacterial meningitis and empirical treatment of febrile neutropenia
Max: The maximum recommended dose for adults (2 g every 8 hours) should not be exceeded
UK SPC, children aged more than 2 months and weighing 40 kg or less with normal renal function: pneumonia, urinary tract infection, skin and subcutaneous tissue infection — 50 mg/kg every 12 hours for 10 days; bacteraemia associated with infections, bacterial meningitis and empirical treatment of febrile neutropenia — 50 mg/kg every 8 hours for 7 to 10 days. Experience in children aged less than 2 months is limited: pharmacokinetic modelling suggests that in children from 1 month to 2 months a dose of 30 mg/kg every 12 or 8 hours can be considered, with careful monitoring. In children weighing more than 40 kg the adult dose is recommended. RENAL IMPAIRMENT: doses of 50 mg/kg (2 months to 12 years) and 30 mg/kg (1 to 2 months) are comparable to a 2 g adult dose — apply the same dosing interval or dose reduction as for renally impaired adults. Verify the paediatric regimen against a children's formulary before use.

Dose adjustments

Renal

Adults: the initial dose in mild to moderate renal insufficiency is the same as for normal renal function; the maintenance dose is then adjusted by creatinine clearance (Cockcroft and Gault). CrCl >50 mL/min — usual dose, no adjustment. CrCl 30 to 50 mL/min — 2 g twice daily / 2 g once daily / 1 g once daily / 500 mg once daily (according to the usual regimen). CrCl 11 to 29 mL/min — 2 g once daily / 1 g once daily / 500 mg once daily / 500 mg once daily. CrCl <10 mL/min — 1 g once daily / 500 mg once daily / 250 mg once daily / 250 mg once daily. Haemodialysis — 500 mg once daily (1 g loading dose on day 1 then 500 mg daily for all infections except febrile neutropenia, which is 1 g daily), given after dialysis on dialysis days.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Paediatric weight-based calculator

UK SPC, children aged more than 2 months and weighing 40 kg or less with normal renal function: pneumonia, urinary tract infection, skin and subcutaneous tissue infection — 50 mg/kg every 12 hours for 10 days; bacteraemia associated with infections, bacterial meningitis and empirical treatment of febrile neutropenia — 50 mg/kg every 8 hours for 7 to 10 days. Experience in children aged less than 2 months is limited: pharmacokinetic modelling suggests that in children from 1 month to 2 months a dose of 30 mg/kg every 12 or 8 hours can be considered, with careful monitoring. In children weighing more than 40 kg the adult dose is recommended. RENAL IMPAIRMENT: doses of 50 mg/kg (2 months to 12 years) and 30 mg/kg (1 to 2 months) are comparable to a 2 g adult dose — apply the same dosing interval or dose reduction as for renally impaired adults. Verify the paediatric regimen against a children's formulary before use.

Verify in a children's formulary

Contraindications

  • Hypersensitivity to cefepime, to any other cephalosporin or to any of the excipients
  • History of severe hypersensitivity reaction (e.g. anaphylactic reaction) to any other type of beta-lactam antibacterial agent (penicillins, monobactams and carbapenems)

Side effects

  • Positive Coombs test (very common)
  • Diarrhoea; skin rash; anaemia and eosinophilia (common)
  • Phlebitis at the infusion site, infusion site reaction, injection site inflammation and pain (common)
  • Raised alkaline phosphatase, ALT, AST, bilirubin and prolonged prothrombin/partial thromboplastin time (common)
  • Neurotoxicity — reversible encephalopathy (confusion, hallucinations, stupor, coma), myoclonus, convulsions including non-convulsive status epilepticus, and/or renal failure, mostly in patients with renal impairment given unadjusted doses (frequency not known)

Interactions

  • Aminoglycosides — increased potential for nephrotoxicity and ototoxicity; monitor renal function (US labelling; the UK SPC §4.5 was not captured in this bundle)
  • Potent diuretics such as furosemide — nephrotoxicity reported with concomitant cephalosporins; monitor renal function (US labelling)
  • Laboratory tests — cefepime may cause a false-positive urinary glucose reaction with some methods; use enzymatic glucose oxidase-based tests. A positive Coombs test is very common

Clinical monograph

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.

Reference: BSAC; UKHSA; MHRA Drug Safety Update; SmPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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