Cefepime (Surgical — Broad-Spectrum Cover)

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.