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[Cefepime (maxipime), large spectrum 4th generation cephalosporin, resistant to beta-lactamases]
Abstract:
As a result of the appearance of bacterial strains resistant to 3rd generation cephlosporin, since 1993 cephalosporins of 4th generation have been developed and introduced in therapy; among them are: cefepime and cefpirome. Cefepime is the most active 4th generation cephalosporin possessing the following advantages over the 3rd generation cephalosporins: high intrinsic potency due to rapid penetration into the periplasmic space; an extended spectrum of activity that includes many Gram-positive and Gram-negative organisms; Activity against multi-resistant Gram-negative bacteria, including Enterobacter and Klebsiella species; Low potential for beta-lactamase induction, especially Bush group 1 beta-lactamases, even ar low periplasmic concentrations; Minimal selection of resistant mutant strains. Its spectrum is very large being very active against Gram-negative bacilii: Enterobacter, Pseudomonas aeruginosa, Klebsiella pneumoniae, Serratia, Citrobacter, Proteus mirabilis and less active against Bacillus fragillis. Cefepime is also very active against Gram-positive cocci: Staphylococcus aureus (methicillin-susceptible strains only), Streptococcus pneumoniae, Streptococcus pyogenes. Some of the methicillin-resistant strains of staphylococcus are susceptible to cefepime; Enterococcus is resistant. Due to its high resistance against beta-lactamases Cefepime (Maxipime) is the best choice in life threatening nosocomial infections occuring in patients in the intensive care units. Cefepime can be synergically associated with aminoglycosides and fluoroquinolones.
Insights
Fourth-generation cephalosporins like cefepime combat resistant bacteria. Cefepime offers broad-spectrum activity and is ideal for severe hospital-acquired infections.
Area of Science:
- Pharmacology
- Infectious Diseases
- Bacteriology
Background:
- Emergence of bacterial resistance to third-generation cephalosporins necessitated the development of new agents.
- Fourth-generation cephalosporins, including cefepime and cefpirome, were introduced to address this challenge.
Purpose of the Study:
- To evaluate the efficacy and spectrum of activity of cefepime.
- To highlight cefepime's advantages over third-generation cephalosporins in treating resistant bacterial infections.
Main Methods:
- Review of existing literature on cefepime's pharmacological properties and clinical applications.
- Analysis of cefepime's in vitro activity against various Gram-positive and Gram-negative bacteria.
- Assessment of cefepime's clinical utility in managing nosocomial infections.
Main Results:
- Cefepime exhibits high intrinsic potency and rapid penetration into the periplasmic space.
- It possesses an extended spectrum of activity against Gram-positive and Gram-negative organisms, including multi-resistant strains.
- Cefepime demonstrates low potential for beta-lactamase induction and minimal selection of resistant mutants.
Conclusions:
- Cefepime is a highly effective fourth-generation cephalosporin with broad-spectrum activity.
- Its potent bactericidal action and resistance to beta-lactamases make it a preferred choice for severe nosocomial infections.
- Cefepime can be used synergistically with aminoglycosides and fluoroquinolones.