Cefepime

4th Gen Cephalosporin·Infectious Diseases - Cephalosporins

Febrile neutropenia, severe hospital-acquired pneumonia, Pseudomonas infections

CEPHALOSPORINMaxipimeVials (1 g, 2 g powder) for…S4TGA

Max Dose

6 g/day

Half-life

2 h

Pseudomonas

COVERED

Neurotoxicity

CRITICAL RISK

Rapid Summary

Overview

Fourth-generation, ultra-broad-spectrum IV cephalosporin. Combines the Gram-positive power of Cefazolin with the Gram-negative (anti-Pseudomonal) power of Ceftazidime.

Maximum Dose

Max 6 g/day (e.g., 2 g q8h for severe Pseudomonas or febrile neutropenia).

Clinical Focus

Renally cleared. Failure to adjust the dose in kidney disease guarantees severe neurotoxicity (myoclonus, non-convulsive status epilepticus, coma).

Bottom Line

Cefepime is a fourth-generation cephalosporin for febrile neutropenia and resistant hospital infections, but can cause neurotoxicity (encephalopathy, seizures) especially in renal impairment.

Formulation & Access

Brand Names

Maxipime

Parenteral

Vials (1 g, 2 g powder) for IV infusion.

Prescribing & PBS

Hospital supply. Highly restricted by Antimicrobial Stewardship.

Indications & Use

Primary

TGA

Febrile neutropenia, severe hospital-acquired pneumonia, Pseudomonas infections.

Clinical Place

Reserved exclusively for life-threatening, highly resistant hospital-acquired infections or immunocompromised hosts.

Quick reference

Class & Role

4th Gen Cephalosporin — Fourth-generation, ultra-broad-spectrum IV cephalosporin.

Route / Formulation

Vials (1 g, 2 g powder) for IV infusion. (Maxipime)

Usual Dose & Max

IV 2 g q8h. Max 6 g/day (e.g., 2 g q8h for severe Pseudomonas or febrile neutropenia).

Key Indication Doses

Febrile Neutropenia / Severe Sepsis: IV 2 g q8h. Complicated UTI: IV 1-2 g q12h. Renal Impairment: Massive dose reduction required. If eGFR 10-30, max 1g q24h. If eGFR < 10, max 500mg q24h. The brain relies on the kidneys to clear this drug.

Best Uses

Cefepime is a fourth-generation cephalosporin for febrile neutropenia and resistant hospital infections, but can cause neurotoxicity (encephalopathy, seizures) especially in renal impairment.

Avoid / Cautions

Cephalosporin anaphylaxis. Pregnancy Category B1.

Key Risks

Neurological: Cefepime-induced encephalopathy. Presents as confusion, agitation, myoclonus (twitching), and refractory non-convulsive status epilepticus. Almost exclusively occurs in unadjusted renal failure. Gastrointestinal: C. difficile infection (destroys normal gut flora). Haematological: Positive Coombs test, rare neutropenia.

Key Interactions

Generally few drug-drug interactions, but additive neurotoxicity if given with other seizure-threshold lowering drugs (like high-dose Tramadol or Imipenem).

Monitoring

Daily U&E and eGFR. The dose MUST be recalculated every single day if the patient's renal function is fluctuating in ICU. If a patient on Cefepime becomes acutely confused or starts twitching, cease the drug immediately and order an EEG.

Clinical Pearl

Unlike Tazocin or Meropenem, Cefepime has ZERO activity against gut anaerobes (Bacteroides). If you are treating an intra-abdominal perforation or appendicitis with Cefepime, you MUST co-prescribe IV Metronidazole.

Access

Maxipime

Brand: Maxipime

Cefepime

4th Gen Cephalosporin·Infectious Diseases - Cephalosporins

Febrile neutropenia, severe hospital-acquired pneumonia, Pseudomonas infections

CEPHALOSPORINMaxipimeVials (1 g, 2 g powder) for…S4TGA

Max Dose

6 g/day

Half-life

2 h

Pseudomonas

COVERED

Neurotoxicity

CRITICAL RISK

Rapid Summary

Overview

Fourth-generation, ultra-broad-spectrum IV cephalosporin. Combines the Gram-positive power of Cefazolin with the Gram-negative (anti-Pseudomonal) power of Ceftazidime.

Maximum Dose

Max 6 g/day (e.g., 2 g q8h for severe Pseudomonas or febrile neutropenia).

Clinical Focus

Renally cleared. Failure to adjust the dose in kidney disease guarantees severe neurotoxicity (myoclonus, non-convulsive status epilepticus, coma).

Bottom Line

Cefepime is a fourth-generation cephalosporin for febrile neutropenia and resistant hospital infections, but can cause neurotoxicity (encephalopathy, seizures) especially in renal impairment.

Formulation & Access

Brand Names

Maxipime

Parenteral

Vials (1 g, 2 g powder) for IV infusion.

Prescribing & PBS

Hospital supply. Highly restricted by Antimicrobial Stewardship.

Indications & Use

Primary

TGA

Febrile neutropenia, severe hospital-acquired pneumonia, Pseudomonas infections.

Clinical Place

Reserved exclusively for life-threatening, highly resistant hospital-acquired infections or immunocompromised hosts.

Quick reference

Class & Role

4th Gen Cephalosporin — Fourth-generation, ultra-broad-spectrum IV cephalosporin.

Route / Formulation

Vials (1 g, 2 g powder) for IV infusion. (Maxipime)

Usual Dose & Max

IV 2 g q8h. Max 6 g/day (e.g., 2 g q8h for severe Pseudomonas or febrile neutropenia).

Key Indication Doses

Best Uses

Cefepime is a fourth-generation cephalosporin for febrile neutropenia and resistant hospital infections, but can cause neurotoxicity (encephalopathy, seizures) especially in renal impairment.

Avoid / Cautions

Cephalosporin anaphylaxis. Pregnancy Category B1.

Key Risks

Key Interactions

Generally few drug-drug interactions, but additive neurotoxicity if given with other seizure-threshold lowering drugs (like high-dose Tramadol or Imipenem).

Monitoring

Clinical Pearl

Access

Maxipime

Brand: Maxipime