Fourth-generation parenteral cephalosporin indicated for pneumonia (moderate to severe), empiric therapy of febrile neutropenic patients, intra-abdominal infections, complicated urinary tract infections, skin and soft-tissue infections, and septicemia.
Also known as: Cefepima, Maxipime
DailyMed approved label (Cefepime Injection, WG Critical Care; setID 5fd857e5-591f-44ca-80cf-fd903660b03c).
DailyMed approved label (Cefepime Injection, WG Critical Care; setID 5fd857e5-591f-44ca-80cf-fd903660b03c).
Cefepime + amikacin: increased risk of nephrotoxicity and ototoxicity — monitor renal function.
The FDA cefepime label documents the aminoglycoside class in the interactions section ("Aminoglycosides: increased potential of nephrotoxicity and ototoxicity. Monitor renal function", 7.2). Amikacin is a broad-spectrum aminoglycoside used mainly against multidrug-resistant Gram-negatives, and the combination with cefepime is common in empirical regimens for severe infections (e.g., nosocomial sepsis, febrile neutropenia). The renal and auditory risk is additive and ototoxicity can be irreversible. Monitoring should include creatinine and urine output, watch for tinnitus, hearing loss and vertigo, and, when available, amikacin serum levels. In the elderly and renally impaired, extend the aminoglycoside interval and reassess the need for the combination daily.
Cefepime + amikacin: additive nephrotoxicity and ototoxicity (aminoglycoside) — monitor renal function and auditory symptoms.
The FDA cefepime label documents the class: "Aminoglycosides: increased potential of nephrotoxicity and ototoxicity. Monitor renal function" (7.2). Amikacin, a broad-spectrum aminoglycoside, is combined with cefepime in empirical regimens for severe infections — the renal and auditory risk is additive.
Monitor amikacin serum levels when applicable.
Rising creatinine, oliguria, tinnitus or hearing loss during the combination.
Monitor renal function and watch for ototoxicity during the combination.
DailyMed/FDA (NIH/NLM) — approved Cefepime label (WG CRITICAL CARE), section 7.2: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5fd857e5-591f-44ca-80cf-fd903660b03c ; approved Amikacin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f260ff2a-76a0-4672-9516-91c344b67890
Cefepime + gentamicin: increased risk of nephrotoxicity and ototoxicity — monitor renal function.
The FDA cefepime label documents in the interactions section that aminoglycosides increase the potential for nephrotoxicity and ototoxicity, with a recommendation to monitor renal function. Gentamicin accumulates in the renal cortex and the inner ear; combining it with a fourth-generation cephalosporin is common in empirical therapy of severe infections (e.g., febrile neutropenia, sepsis), so the additive risk is clinically frequent. Monitoring should include creatinine and urine output, and watch for tinnitus, hearing loss and vertigo — signs of sometimes irreversible ototoxicity. In the elderly and renally impaired, consider extending the gentamicin interval and, when available, monitoring aminoglycoside serum levels.
Cefepime + gentamicin: additive nephrotoxicity and ototoxicity — monitor renal function and auditory/vestibular symptoms.
The FDA cefepime label documents: "Aminoglycosides: increased potential of nephrotoxicity and ototoxicity. Monitor renal function" (7.2). Combining a fourth-generation cephalosporin with an aminoglycoside is common in empirical therapy of severe infections, but the additive renal and auditory risk requires monitoring, especially in the elderly and renally impaired.
Monitor aminoglycoside serum levels when applicable and vestibular/auditory symptoms.
Rising creatinine, oliguria, tinnitus or hearing loss during the combination.
Monitor renal function (creatinine, urine output) and watch for ototoxicity (tinnitus, hearing loss) during the combination.
DailyMed/FDA (NIH/NLM) — approved Cefepime label (section 7.2): https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5fd857e5-591f-44ca-80cf-fd903660b03c ; approved Gentamicin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=441b6232-bb60-40ad-85ec-7c41ba43fd5f
Cefepime + furosemide: nephrotoxicity reported with potent diuretics — monitor renal function.
The FDA cefepime label documents that nephrotoxicity has been reported after concomitant administration of other cephalosporins with potent diuretics such as furosemide, with a recommendation to monitor renal function. The mechanism is multifactorial: diuretic-induced volume depletion reduces renal perfusion and glomerular autoregulation, increasing tubular exposure to the cephalosporin. The risk is higher in the elderly, dehydrated and hospitalised patients, especially with high diuretic doses. Monitoring should include creatinine, urine output and fluid balance; maintaining adequate hydration reduces the risk of associated renal injury.
Cefepime + furosemide: nephrotoxicity reported with potent diuretics — monitor renal function.
The FDA cefepime label documents: "Diuretics: nephrotoxicity has been reported following concomitant administration of other cephalosporins with potent diuretics such as furosemide. Monitor renal function" (7.3). The mechanism is multifactorial (volume depletion, interference with renal autoregulation) and relevant mainly in the elderly and inpatients.
Monitor electrolytes and patient hydration.
Rising creatinine or oliguria in a patient receiving cefepime and furosemide.
Monitor renal function (creatinine, urine output) during the combination, especially in the elderly.
DailyMed/FDA (NIH/NLM) — approved Cefepime label (section 7.3): https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5fd857e5-591f-44ca-80cf-fd903660b03c ; approved Furosemide label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5886e233-b2da-4acb-be05-9bf40fb8e7f4
Cefepime + tobramycin: increased risk of nephrotoxicity and ototoxicity — monitor renal function.
The FDA cefepime label documents the aminoglycoside class with increased potential for nephrotoxicity and ototoxicity and a recommendation to monitor renal function (7.2). Tobramycin is used mainly in Pseudomonas infections and is combined with cefepime in directed or empirical regimens for severe infections. The renal and auditory risk is additive; ototoxicity (tinnitus, hearing loss, vertigo) can be irreversible and renal impairment is more frequent in the elderly and in patients with borderline renal function. Monitoring includes creatinine, urine output and vestibular/auditory symptoms; when applicable, tobramycin serum levels. Consider the shortest possible duration of the combination.
Cefepime + tobramycin: additive nephrotoxicity and ototoxicity (aminoglycoside) — monitor renal function and auditory symptoms.
The FDA cefepime label documents the class: "Aminoglycosides: increased potential of nephrotoxicity and ototoxicity. Monitor renal function" (7.2). Tobramycin, used mainly against Pseudomonas, is combined with cefepime in severe infections — additive renal and auditory risk.
Monitor tobramycin serum levels when applicable.
Rising creatinine, oliguria, tinnitus or hearing loss during the combination.
Monitor renal function and watch for ototoxicity during the combination.
DailyMed/FDA (NIH/NLM) — approved Cefepime label (WG CRITICAL CARE), section 7.2: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5fd857e5-591f-44ca-80cf-fd903660b03c ; approved Tobramycin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c4751a4f-c9c1-60c5-e053-2995a90aeba9
Cefepime + streptomycin: increased risk of nephrotoxicity and ototoxicity — monitor renal function.
The FDA cefepime label documents the aminoglycoside class with increased potential for nephrotoxicity and ototoxicity (7.2). Streptomycin is the classic aminoglycoside, still used in endocarditis (e.g., Streptococcus) and tuberculosis; the combination with cefepime has additive renal and auditory risk. Streptomycin vestibular and cochlear ototoxicity is well known and can be irreversible. Monitoring should include renal function, vestibular symptoms (vertigo, nystagmus) and auditory symptoms (tinnitus, hearing loss), and the duration of the combination should be as short as possible. In the renally impaired or elderly, the aminoglycoside interval should be extended.
Cefepime + streptomycin: additive nephrotoxicity and ototoxicity (aminoglycoside) — monitor renal function and auditory symptoms.
The FDA cefepime label documents the class: "Aminoglycosides: increased potential of nephrotoxicity and ototoxicity. Monitor renal function" (7.2). Streptomycin is the classic aminoglycoside — combining with cefepime (e.g., in Streptococcus endocarditis) carries additive renal and auditory risk.
Monitor streptomycin serum levels when applicable.
Rising creatinine, oliguria, tinnitus or hearing loss during the combination.
Monitor renal function and watch for ototoxicity during the combination.
DailyMed/FDA (NIH/NLM) — approved Cefepime label (WG CRITICAL CARE), section 7.2: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5fd857e5-591f-44ca-80cf-fd903660b03c ; approved Streptomycin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=78982c98-7866-49f1-989f-a289c4242358
Cefepime is given intravenously or intramuscularly; food does not affect its pharmacokinetics.
May be administered regardless of meals.
DailyMed/FDA (NIH/NLM) — approved Cefepime Injection label (WG Critical Care): https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5fd857e5-591f-44ca-80cf-fd903660b03c
No relevant pharmacokinetic interaction with cefepime.
Moderate alcohol intake.
DailyMed/FDA (NIH/NLM) — approved Cefepime Injection label (WG Critical Care): https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5fd857e5-591f-44ca-80cf-fd903660b03c
Cefepime is contraindicated in patients with documented cephalosporin allergy (risk of anaphylaxis).
Confirm allergy history before administering.
DailyMed/FDA (NIH/NLM) — approved Cefepime Injection label (WG Critical Care): https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5fd857e5-591f-44ca-80cf-fd903660b03c
Cefepime is eliminated renally; renal impairment requires dose adjustment and monitoring (risk of neurotoxicity at unadjusted doses).
Adjust the dose based on renal function and monitor neurological symptoms.
DailyMed/FDA (NIH/NLM) — approved Cefepime Injection label (WG Critical Care): https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5fd857e5-591f-44ca-80cf-fd903660b03c
Data on cefepime in pregnancy are limited; use only if the benefit outweighs the risk.
Use only in severe infections with no safe alternative.
Present in breast milk in small amounts; generally compatible.
No specific contraception required.
DailyMed/FDA (NIH/NLM) — approved Cefepime Injection label (WG Critical Care): https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5fd857e5-591f-44ca-80cf-fd903660b03c
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
Fourth-generation cephalosporin: efficacy correlates with time above the MIC (pharmacodynamic parameter validated in animal models). Extended spectrum including Pseudomonas aeruginosa and Enterobacter spp.
Inhibition of cell-wall synthesis by binding to PBPs; stable to hydrolysis by most chromosomal and plasmidial beta-lactamases, including many AmpC.
Exclusively parenteral administration (IV/IM); IM absorption is complete, with ~82% bioavailability after a 50 mg/kg IM dose in children.
Predominantly renal elimination: mean half-life of 2 (±0.3) h and total clearance of 120 (±8) mL/min in healthy volunteers; linear pharmacokinetics between 250 mg and 2 g, with no accumulation on repeated dosing.
Mean elimination half-life of 2 (±0.3) h; prolonged to ~13 h in patients on hemodialysis.
Medicines from the same therapeutic group (ATC classification) or the same pharmacological class.
