Cefepime: a new fourth-generation cephalosporin

Area of Science:

• Pharmacology and Infectious Diseases
• Antibiotic Chemistry and Microbiology
• Clinical Efficacy and Therapeutics

Background:

• Cefepime is a fourth-generation cephalosporin antibiotic with a zwitterionic structure.
• Its chemical properties, including a positively charged quaternary nitrogen, contribute to its stability and spectrum of activity.
• The 7-position side chain enhances stability against beta-lactamase enzymes.

Purpose of the Study:

• To review the chemistry, pharmacology, antimicrobial spectrum, pharmacokinetics, clinical efficacy, adverse effects, and dosage of cefepime.
• To evaluate cefepime's effectiveness and safety profile in treating various bacterial infections.
• To compare cefepime's performance against other cephalosporin antibiotics.

Main Methods:

• Review of existing literature on cefepime's properties and clinical data.
• Analysis of in vitro antimicrobial activity against various bacterial strains.
• Evaluation of clinical trial data assessing efficacy and adverse events.

Main Results:

• Cefepime exhibits good activity against Gram-positive (e.g., Staphylococcus aureus) and Gram-negative organisms (e.g., Pseudomonas aeruginosa).
• It is not active against Enterococcus faecalis, Clostridium difficile, and resistant strains of Staphylococcus aureus.
• Clinical studies show cefepime is as effective as cefotaxime or ceftazidime for lower respiratory tract, skin, urinary, and female reproductive system infections.
• Common adverse effects include headache, nausea, rash, and diarrhea.

Conclusions:

• Cefepime is a valuable antibiotic with broad-spectrum activity and comparable clinical efficacy to other cephalosporins.
• Its pharmacokinetic profile supports effective therapeutic concentrations.
• Dosage adjustments are necessary based on creatinine clearance, and common adverse effects are generally mild.