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Fourth-Generation Cephalosporin Pregnancy: There are insufficient data on exposure in pregnancy; animal studies do not indicate direct or indirect harmful effects on pregnancy, embryonal/foetal development, labour or post-natal development. Should only be prescribed to pregnant women with great caution. Breast-feeding: cefepime is excreted in human milk in very low quantities — caution is recommended.

Cefepime (Surgical — Broad-Spectrum Cover)

Brand names: Maxipime

Cefepime is a fourth-generation intravenous cephalosporin used in surgical and critical care settings for broad-spectrum cover of serious Gram-negative and Gram-positive infections, including some resistant organisms.

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: By infection severity — 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 for mild to moderate and severe infections; every 8 hours for very severe or life-threatening infections
Max: The maximum recommended dose for adults (2 g every 8 hours) should not be exceeded
SOURCE: eMC UK SPC, 'Renapime 1g Powder for solution for injection/infusion', §4.2. Applies to adults and children weighing over 40 kg with normal renal function. NOTE: the SPC gives no dedicated surgical-prophylaxis regimen — these are treatment doses for established infection; a surgical prophylaxis regimen must be sourced separately if the page needs one. DURATION: usually 7 to 10 days; more severe infections can require more prolonged treatment. In empirical treatment of febrile neutropenia the usual duration should not be less than 7 days or until resolution of the neutropenia. Patients weighing 40 kg or less should receive the paediatric posology. ELDERLY: no dose adjustment with normal renal function; adjust in renal impairment. HEPATIC IMPAIRMENT: no dose adjustment required. The SPC notes cefepime has a relatively limited spectrum and is not suitable for some infections unless the pathogen is documented or very strongly suspected to be susceptible. §4.4 and §4.8 text was truncated at the source-fetch limit. US labelling (cross-check) gives 1 to 2 g IV every 8 to 12 hours for moderate to severe pneumonia and 2 g IV every 8 hours for Pseudomonas aeruginosa and for empiric therapy of febrile neutropenia.

Paediatric dose

Dose: 50 mg/kg
Route: Intravenous or intramuscular (experience with the intramuscular route in children is limited)
Frequency: Every 12 hours for pneumonia, urinary tract infection and skin/subcutaneous tissue infection (8-hourly in more severe infections); 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
Applies to children aged more than 2 months and weighing 40 kg or less. Duration: 10 days for pneumonia, UTI and skin/subcutaneous tissue infection; 7 to 10 days for bacteraemia, bacterial meningitis and febrile neutropenia. Children weighing more than 40 kg should receive the adult dose. UNDER 2 MONTHS: experience is limited — data from pharmacokinetic models in children over 2 months suggest 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. RENAL IMPAIRMENT: 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 the same dose reduction as recommended for renally impaired adults. Verify all under-18 dosing against a children's formulary.

Dose adjustments

Renal

Adjust the dose when creatinine clearance is 50 ml/min or less (initial dose unchanged; maintenance dose reduced). SPC §4.2 maintenance table — the four values in each row correspond to the normal-renal-function regimens 2 g 3x/day, 2 g 2x/day, 1 g 2x/day and 500 mg 2x/day respectively: CrCl above 50 ml/min — usual dose, no adjustment; CrCl 30 to 50 — 2 g 2x/day, 2 g 1x/day, 1 g 1x/day, 500 mg 1x/day; CrCl 11 to 29 — 2 g 1x/day, 1 g 1x/day, 500 mg 1x/day, 500 mg 1x/day; CrCl below 10 — 1 g 1x/day, 500 mg 1x/day, 250 mg 1x/day, 250 mg 1x/day; haemodialysis — 500 mg 1x/day for each. CAUTION: the table's column alignment was flattened in the fetched text — the clinician must confirm the mapping against the published SPC table. HAEMODIALYSIS: 1 gram loading dose on the first day of treatment then 500 mg daily for all infections, except febrile neutropenia which is 1 gram daily; give after dialysis, at the same time each day (about 68% of body cefepime is removed during a 3-hour dialysis). CAPD: 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.

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

Applies to children aged more than 2 months and weighing 40 kg or less. Duration: 10 days for pneumonia, UTI and skin/subcutaneous tissue infection; 7 to 10 days for bacteraemia, bacterial meningitis and febrile neutropenia. Children weighing more than 40 kg should receive the adult dose. UNDER 2 MONTHS: experience is limited — data from pharmacokinetic models in children over 2 months suggest 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. RENAL IMPAIRMENT: 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 the same dose reduction as recommended for renally impaired adults. Verify all under-18 dosing against a children's formulary.

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

  • Diarrhoea (common); pseudomembranous colitis, colitis, nausea, vomiting (uncommon)
  • Skin rash (common); erythema, urticaria, pruritus (uncommon); toxic epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme (not known)
  • Phlebitis at the infusion site, infusion site reaction, injection site inflammation and pain (common)
  • Anaemia and eosinophilia (common); thrombocytopenia, leukopenia, neutropenia (uncommon); positive Coombs test (very common)
  • Neurotoxicity — convulsions, paraesthesia, dizziness (rare); coma, stupor, encephalopathy, altered consciousness, myoclonus (not known), mostly in patients with renal impairment given unadjusted doses; renal failure and increased blood urea/creatinine

Interactions

  • NOTE: eMC §4.5 was not captured in this bundle — the interactions below are from the US labelling and must be checked against the UK SPC §4.5 before publication
  • Aminoglycosides — increased potential for nephrotoxicity and ototoxicity; monitor renal function
  • Potent diuretics such as furosemide — nephrotoxicity has been reported with other cephalosporins; monitor renal function
  • Laboratory tests — cefepime may cause a false-positive urine glucose reaction with some methods; use glucose oxidase-based tests

Clinical monograph

How it works

It inhibits bacterial cell wall synthesis by binding penicillin-binding proteins and is stable against many beta-lactamases.

Prescribing in practice

  • Do not give to patients with a history of severe or anaphylactic reaction to penicillins or cephalosporins, owing to the risk of cross-reactivity.
  • The dose must be reduced in renal impairment, as accumulation can cause neurotoxicity including encephalopathy, confusion, myoclonus, and non-convulsive seizures.
  • Broad-spectrum use carries a risk of Clostridioides difficile infection and antimicrobial resistance, so duration should be guided by stewardship.

Monitoring

Monitor renal function with dose adjustment, neurological status particularly in renal impairment, and clinical response to therapy.

Counselling the patient

  • This antibiotic is given by a drip into a vein.
  • Report any new rash, swelling, or difficulty breathing immediately.
  • Tell staff if you become confused, develop twitching, or feel persistently unwell or have diarrhoea.

Evidence & guidelines

Cefepime is an established broad-spectrum cephalosporin with documented efficacy in serious Gram-negative infection and a recognised dose-related neurotoxicity signal.

Reference: MHRA Drug Safety Update 2012 (cefepime neurotoxicity); PHE Antimicrobial Stewardship Guidelines; IDSA Febrile Neutropenia Guidelines 2011; 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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