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Pharmacologic class: Fourth-generation cephalosporin
Therapeutic class: Anti-infective
Pregnancy risk category B
Interferes with bacterial cell-wall synthesis and division by binding to cell wall, causing cell to die. Active against gram-negative and gram-positive bacteria, with expanded activity against gram-negative bacteria. Exhibits minimal immunosuppressant activity.
Powder for injection: 500-mg vial, 1-g vial, 2-g vial; 1-g and 2-g piggyback bottles
Solution for injection (premixed): 1 g (50 ml in iso-osmotic dextrose), 2 g (100 ml in iso-osmotic dextrose)
Indications and dosages
➣ Urinary tract infections (UTIs) caused by Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis
Adults: 500 mg to 1g by I.V. infusion or I.M. q 12 hours for 7 to 10 days
➣ Severe UTIs caused by E. coli or K. pneumoniae; moderate to severe skin infections caused by Staphylococcus aureus or Streptococcus pyogenes
Adults: 2 g by I.V. infusion q 12 hours for 10 days
➣ Febrile neutropenia
Adults and children ages 2 months to 16 years: 2 g by I.V. infusion q 8 hours for 7 days
➣ Complicated intra-abdominal infections caused by alpha-hemolytic streptococci, E. coli, K. pneumoniae, Pseudomonas aeruginosa, Enterobacter species, or Bacteroides fragilis
Adults: 2 g by I.V. infusion q 12 hours for 7 to 10 days (given with metronidazole)
➣ Moderate to severe pneumonia caused by K. pneumoniae, P. aeruginosa, Enterobacter species, or Streptococcus pneumoniae
Adults: 1 to 2 g by I.V. infusion q 12 hours for 10 days
• Renal impairment
• Hypersensitivity to cephalosporins or penicillins
Use cautiously in:
• renal impairment, phenylketonuria
• history of GI disease
• elderly patients
• pregnant or breastfeeding patients
• Don't mix premixed solution with other drugs.
☞ Don't use flexible container in series connections because of risk of air embolism.
• Obtain specimens for culture and sensitivity testing as needed before starting therapy.
• Don't mix with ampicillin (at concentrations above 40 mg/ml), metronidazole, aminoglycosides, or aminophylline if ordered concurrently. Give each drug separately.
• For I.V. infusion, use small I.V. needle and infuse into large vein over 30 to 60 minutes.
• For I.M. administration, inject deep into large muscle.
CNS: headache, lethargy, paresthesia, syncope, seizures
CV: phlebitis, hypotension, palpitations, chest pain, vasodilation, thrombophlebitis
EENT: hearing loss
GI: nausea, vomiting, diarrhea, abdominal cramps, oral candidiasis, pseudomembranous colitis
GU: vaginal candidiasis, nephrotoxicity
Hematologic: lymphocytosis, eosinophilia, bleeding tendency, hemolytic anemia, hypoprothrombinemia, neutropenia, thrombocytopenia, agranulocytosis, bone marrow depression
Hepatic: hepatic failure, hepatomegaly
Skin: urticaria, maculopapular or erythematous rash, redness, swelling, induration
Other: chills, fever, superinfection, pain at I.M. site, phlebitis at I.V. site, anaphylaxis, serum sickness
Drug-drug. Aminoglycosides, loop diuretics: increased risk of nephrotoxicity
Probenecid: decreased excretion and increased blood level of cefepime
Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, blood urea nitrogen, creatinine, eosinophils, gamma-glutamyltransferase, lactate dehydrogenase: increased levels
Coombs' test, urinary 17-ketosteroids, nonenzyme-based urine glucose tests (such as Clinitest): false-positive results
Hemoglobin, platelets, white blood cells: decreased values
Drug-herbs. Angelica, anise, arnica, asafetida, bogbean, boldo, celery, chamomile, clove, danshen, fenugreek, feverfew, garlic, ginger, ginkgo, ginseng, horse chestnut, horseradish, licorice, meadowsweet, onion, papain, passionflower, poplar, prickly ash, quassia, red clover, turmeric, wild carrot, wild lettuce, willow: increased risk of bleeding
• Assess baseline CBC and kidney and liver function test results.
• Monitor for signs and symptoms of superinfection and other serious adverse reactions.
• Monitor for inflammation at infusion site.
• Be aware that cross-sensitivity to penicillins may occur.
• Instruct patient to report reduced urinary output, persistent diarrhea, bruising, petechiae, or bleeding.
• Caution patient not to take herbs without consulting prescriber.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.