Section 15 · Monograph
Cefepime
Reviewed Nov 2026FDA label
Maxipime4th-generation cephalosporin
- Forms
- IV: 1, 2g
- Dose
- Healthcare-associated or Pseudomonas meningitis: 2g IV every 8 hours (renal adjustment required)
- MOA
- Binds PBPs; good CSF penetration with inflamed meninges
Indications
- Pneumonia, febrile neutropenia, urinary tract infection, skin and intra-abdominal infectionsFDA-labeled
Off-Label Uses
- Healthcare-associated or Pseudomonas bacterial meningitis and ventriculitisOff-label
- Postneurosurgical CNS infectionOff-label
Mechanism of Action
- Fourth-generation cephalosporin that inhibits cell-wall synthesis with broad gram-negative (including Pseudomonas) and gram-positive activity; reaches therapeutic CSF levels with inflamed meninges
Full Dosing
Adult / usual
- Meningitis (off-label): 2g IV every 8 hours
Renal
- Renal adjustment (for the 2g every 8 hours regimen): CrCl 30-60 — 2g every 12 hours; 11-29 — 2g every 24 hours; under 11 — 1g every 24 hours
- Neurotoxicity risk is dose- and renal-function dependent
Contraindications
- Hypersensitivity to cefepime or other cephalosporins, penicillins or beta-lactams (severe, immediate)
Drug Interactions
- Aminoglycosides and loop diuretics: additive nephrotoxicity
- Probenecid increases levels
Adverse Effects
- Encephalopathy, myoclonus, seizures and nonconvulsive status epilepticus (particularly with renal impairment or overdosing)
- Diarrhea and Clostridioides difficile infection
- Hypersensitivity reactions
- Positive direct Coombs test
Monitoring Parameters
- Renal function and dose adjustment
- Mental status — new confusion or myoclonus warrants prompt dose reduction or change
- EEG if nonconvulsive seizures suspected
Pregnancy & Lactation
- Generally considered acceptable; limited data
- Small amounts in milk