Cefepim

Cefepime is an antibiotic of the fourth generation, belonging to the group of cephalosporins of beta-lactam action.

The principle of the main action is directed to the destruction of the cell wall of the microbial cell; the drug acts bactericidal. The drug shows a high antibacterial activity against strains that are resistant to the action of cephalosporins of the third generation, aminoglycosides. The active substance quickly penetrates the gram-negative microbial cell, while possessing high resistance to the hydrolysis of many beta-lactamases. The main target within the cell for cefepime is the penicillin-binding protein.

The antibiotic Cefepime acts on gram-positive flora and Gram-negative bacteria in vitro and in vivo: streptococci, enterobacteria, coli escherichia, klebsiella, clostridia, proteas, etc.

Clinical and pharmacological group

Cephalosporin antibiotic IV generation.

Terms of sale from pharmacies

Can buyby prescription.

Price

How much does Cefepime cost in pharmacies? The average price is at the level of120 rubles.

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Composition and form of release

The agent is in the form of a powder for making a solution intended for intramuscular or intravenous administration. In the form of tablets, the drug is not released, because the active ingredient (cefepime hydrochloride) is not absorbed from the gastrointestinal tract (like most cephalosporins).

Powder of white color with a yellowish hue at dilution gives a solution of yellow color, is packed into glass bottles of 10 ml. Each vial is supplied with an ampoule with a solvent (lidocaine) of 5 ml. Contents of main and auxiliary components:

Pharmacological effect

Cefepime is an antibiotic of the fourth generation, belonging to the group of cephalosporins of beta-lactam action. Active against gram-positive and gram-negative bacteria, including those microorganisms that are more not sensitive to aminoglycosides and cephalosporins of the third generation (for example, ceftazidime).

The drug inhibits the formation of cell membrane enzymes. Cefepime is highly resistant to the effects of most beta-lactamases. It is effective against the following microorganisms: Staphylococcus saprophytus, Staphylococcus epidermidis, Staphylococcus aureus, Streptococcus pneumonia (including those strains that are resistant to penicillin), Staphylococcus pyogenes, Streptococcus agalactive (B), Streptococcus viridans, Escherichia coli, Klebsiella spp, Proteus spp (including Proteus mirabilis and Proteus vulgaris), Gardnerella vaginalis, Aeromonas hydrophilla, Enterobacter spp. (including Enterobacter cloacae and Enterobacter agglomerans), Neisseria gonorrhoeae, Acinetobacter calcoaceticus, Campylobacter jejuni, Salmonella spp., Haemophilus parainfuenzae, Morganella morgani, Legionella spp., Providenzia spp., Shigella spp., Serratia, Peptostreptococcus spp., Bacteriodes spp., Mobiluncus spp., Clostridium perfringens, Capnocytophaga spp.

Not sensitive to Cefepime is staphylococcus, resistant to methicillin, as well as Enterecoccus faecalis, Bacteroides fragilis and some strains of Pseudomonas maltophilia.

Indications for use

Antibiotic prescribe for severe and moderate pneumonia, caused by streptococci, enterococci, klebsiella and other microorganisms sensitive to the action of the drug.

Instructions for use Cefepime contains the following indications for the use of the drug: infectious lesions of the urinary tract (complicated and uncomplicated forms), febrile neutropenia, uncomplicated infectious diseases of the skin and adjacent to them soft tissues.

The medication is recommended for use in complicated intra-abdominal infectious lesions (in complex therapy with metronidazole).

Contraindications

Before starting therapy with Cefepime, patients should carefully read the accompanying instructions. The injections are not prescribed if the patient has one or more conditions:

the age of children under 2 months (for intravenous administration) - this is due to the lack of experience and unproven safety;
age up to 12 years for intramuscular injection;
individual intolerance to the drug;
cases of severe allergic reactions to antibiotics from the group of cephalosporins;
increased sensitivity to penicillins - possible cross-intolerance of cephalosporins;
pseudomembranous colitis, including in the anamnesis;
pregnancy and the period of breastfeeding.

Relative contraindications to the appointment of Cefepime injections are chronic liver disease, ulcerative colitis, the age of patients older than 65 years.

Intended use for pregnancy and lactation

The use of cefepime is possible only in exceptional cases, when the expected effect of therapy for the mother significantly exceeds the potential threat to the fetus:

in the form of a powder for IV and / m introduction - in the II and III trimesters of pregnancy (I trimester is an absolute contraindication for this dosage form);
in the form of powder for the / m introduction - the entire period of pregnancy.

Contraindicated use of the drug during lactation. For clinical indications requiring the appointment of Cefepime, breastfeeding should be temporarily discontinued.

Dosage and route of administration

As indicated in the instructions for use, the dosage regimen of Cefepime is strictly individual, depending on the sensitivity of the pathogen, the severity of the infection, and the state of kidney function.

The IV route is preferred for patients with severe or life-threatening infections, especially when there is a threat of shock.

With a / m or / in the introduction of adults and children with a body weight of more than 40 kg with normal kidney function, a single dose is 0.5-1 g, the interval between administrations is 12 hours. In severe infections, iv is given at a dose of 2 g every 12 hours.

In order to prevent infections in the conduct of cavitary surgery are used in combination with metronidazole according to the scheme.

For children aged 2 months, the maximum dose should not exceed the recommended dose for adults. The average dose for children weighing up to 40 kg with complicated or uncomplicated urinary tract infections (including pyelonephritis), uncomplicated skin and soft tissue infections, pneumonia, empirical treatment of neutropenic fever is 50 mg / kg every 12 hours.

Patients with neutropenic fever and bacterial meningitis - 50 mg / kg every 8 hours.

The average duration of therapy is 7-10 days. In severe infections, longer treatment may be required.

For violations of kidney function (KK less than 30 ml / min), correction of the dosing regimen is necessary. The initial dose of cefepime should be the same as for patients with normal renal function. Supportive doses are determined depending on the values of CK or the serum creatinine concentration.

With hemodialysis, approximately 68% of the total amount of cefepime is removed from the body within 3 hours. At the conclusion of each session, a repeat dose equal to the initial dose should be given. In patients on continuous outpatient peritoneal dialysis, cefepime can be used in medium recommended doses, i. 500 mg, 1 g or 2 g, depending on the severity of the infection, with an interval between single dose administration of 48 hours.

Children with impaired renal function are recommended the same changes in the dosing regimen as adults, since the pharmacokinetics of cefepime in adults and children is similar.

Adverse Reactions

On the background of therapy with Cefepime injections, patients with hypersensitivity to cephalosporins may experience adverse reactions that clinically manifest themselves as follows:

from the cardiovascular system: chest pain, tachycardia;
from the respiratory system: shortness of breath, sore throat, cough;
laboratory parameters: a decrease in hematocrit, an increase in the level of urea, activity of hepatic enzymes and / or alkaline phosphatase, hypercreatininaemia, hyperbilirubinemia, hypercalcemia, increased prothrombin time, false positive urine glucose test, positive Coombs direct test;
from the side of the nervous system: insomnia, headache, anxiety, dizziness, confusion, convulsions, paresthesia;
allergic reactions: itching, erythema, skin rash, fever, eosinophilia, multiforme exudative erythema (including Stevens-Johnson syndrome), anaphylactoid reactions; rarely - Lyell's syndrome;
on the part of the reproductive system: vaginitis;
from the gastrointestinal tract: abdominal pain, nausea, vomiting, dyspepsia, diarrhea, constipation, against a background of prolonged therapy - dysbiosis; extremely rarely - pseudomembranous enterocolitis;
from the urinary system: very rarely - toxic nephropathy, functional renal impairment;
hemopoiesis: increased bleeding, anemia, leukopenia, transient thrombocytopenia, neutropenia, hemolytic anemia, pancytopenia;
local reactions: with iv injection - phlebitis, with the / m introduction - pain at the injection site, hyperemia;
Other: increased sweating, candidiasis, back pain, sore throat, asthenia, peripheral edema.

Overdose Symptoms

In case of a significant excess of the recommended dose of the drug, an overdose of Cefepime may occur. Its symptoms can be: encephalopathy, hallucinations, confusion, stupor or coma. In some cases, neuromuscular activity and epileptic seizures were observed.

As a treatment it is recommended to stop the drug immediately, to conduct hemodialysis. Continue supportive and symptomatic therapy.

special instructions

Before you start using the drug, read the special instructions:

When developing allergic reactions cefepime should be discarded.
Safety and effectiveness of cefepime in children under 2 months of age have not been established.
With particular caution apply cefepime together with aminoglycosides and loop diuretics.
Use with caution in patients at risk of developing allergic reactions, especially on drugs.
Serious reactions of immediate type hypersensitivity may require the use of epinephrine (adrenaline) and other forms of maintenance treatment.
In the development of superinfection, cefepime should be immediately discontinued and appropriate treatment should be prescribed.
When diarrhea appears on the background of treatment, the possibility of developing pseudomembranous colitis should be considered. In such cases, cefepime should be immediately discontinued and, if necessary, appropriate treatment should be prescribed.
With the use of other antibiotics of the cephalosporin group, urticaria, Stevens-Johnson syndrome, erythema multiforme, toxic epidermal necrolysis, colitis, renal dysfunction, toxic nephropathy, aplastic anemia, hemolytic anemia, hemorrhage, convulsions, impaired liver function, including cholestasis, false positive results of urine glucose tests.
When used in patients at high risk of infection due to mixed aerobic / anaerobic microflora (including in cases where one of the pathogens is Bacteroides fragilis), before identifying the causative agent it is recommended to prescribe simultaneously with cefepime a drug that is active against anaerobes.

Compatibility with other drugs

With simultaneous administration of a solution of cefepime with solutions of metronidazole, vancomycin, gentamicin, tobramycin sulfate and netilmicin sulfate, a pharmaceutical interaction is possible.

Patient Reviews

We offer you to read reviews of people who used Cefepim:

Nastya. Means Cefepime I was pricked during pneumonia. After several days with a high temperature, the ambulance was hospitalized, the diagnosis was made quickly, these injections were done twice a day, through a vein. It became better on the third day - the temperature dropped a little, the general state of health stabilized. The general course of treatment was 12 days.
Marina. To the son of 6 years, have put a pneumonia. hospitalized. The first 7 days pricked this antibiotic, every 10 hours. Improvements were not, the temperature did not fall, the cough increased. The drug was replaced, the attending physician said that it was initially incorrect to determine the type of pathogen. After the replacement it became better on the third day, for two weeks recovered completely.

Analogues

Structural analogs for the active substance:

Cefepime;
Ladef;
Maksipim;
Maksitsef;
Movizar;
We chain;
Cefepime with arginine;
Cefepim Agio;
Cefepim Alkem;
Cefepim Vial;
Cephepim Jodas;
Cefepime hydrochloride;
Cefomax;
Etipim.

Before buying an analogue, consult your doctor.

Shelf life and storage conditions

It is possible to store the powder for three years from the production date indicated on the package. Keep away from children. The solution of the product is stored no more than 24 hours at room temperature, and up to 7 days - in the refrigerator.