Cefepime - instructions for use, dose, side effects, contraindications

Has bactericidal action due to inhibition of bacterial cell wall synthesis. Violates the synthesis of the biopolymer peptidoglikana - the main component of the cell wall of bacteria. It inhibits the peptidoglycan transpeptidase, inhibits the activity of the endogenous inhibitor, which leads to activation of murein hydrolase, which cleaves peptidoglycan. Effective against fissile bacteria, in the walls of which the synthesis of peptidoglycan occurs.

Active with gram-positive: Staphylococcus aureus, Staphylococcus epidermidis, S. hominis, S. saprophyticus, Streptococcus pyogenes (group A), Streptococcus agalactiae (group B), Streptococcus pneumoniae other β-hemolytic streptococci (groups C, G, F), S. bovis (group D), S. Viridans; Gram-negative aerobes: Pseudomonas spp., Enterobacter spp. (including E. cloacae, E. aerogenes, E. agglomerans, E. sakazakii), Proteus spp., Acinetobacter calcoaceticus (subsp. Anitratus, Iwofii), Aeromonas hydrophila, Capnocytophaga spp., Citrobacter spp, Campylobacter jejuni, Gardnerella vaginalis, Haemophilus ducreyi, Haemophilus influenzae, Haemophilus parainfluenzae, Hafnia alvei, Legionella spp., Morganella morganii, Moraxella catarrhalis, Neisseria gonorrhoeae, Neisseria meningitidis, Providencia spp., Salmonella spp ., Serratia, Shigella spp., Yersinia enterocolitica; a also anaerobes: Bacteroides spp., Clostridium perfringens, Fusobacterium spp., Mobiluncus spp., Peptostreptococcus spp., Veillonella spp.

Inactive at respect Bacteroides fragilis and Clostridium difficile.

Highly resistant to hydrolysis by most β-lactamases, especially chromosome-mediated ones.

Pharmacokinetics:

After intramuscular injection, the maximum concentration in the blood plasma is reached after 30-120 minutes, after intravenous administration - after 10 minutes. It binds to plasma proteins up to 19%.

Not exposed to metabolism. Penetrates through the placental and blood-brain barrier (with inflammatory changes in the meninges) barrier, found in breast milk.

The elimination half-life is 2 hours, during hemodialysis, the half-life is 13 hours, with continuous ambulatory peritoneal dialysis - 19 hours.

Elimination of the kidneys unchanged.

Indications:

It is used to treat infections caused by pathogens that are sensitive to cefepime: respiratory tract, including pneumonia and bronchitis, urinary tract, skin and soft tissues, intra-abdominal infections, including peritonitis and bile duct infections. It is used for gynecological infections, septicemia, for the purpose of empirical treatment for febrile neutropenia.

ICD-10

I.A30-A49.A39 Meningococcal infection

I.A30-A49.A40 Streptococcal septicemia

I.A30-A49.A41 Other septicemia

VI.G00-G09.G00 Bacterial meningitis, not elsewhere classified

X.J00-J06.J00 Acute nasopharyngitis (runny nose)

X.J30-J39.J31.1 Chronic nasopharyngitis

X.J30-J39.J31 Chronic rhinitis, nasopharyngitis and pharyngitis

X.J00-J06.J01 Acute Sinusitis

X.J30-J39.J32.9 Chronic sinusitis, unspecified

X.J30-J39.J31.2 Chronic pharyngitis

X.J00-J06.J02 Acute pharyngitis

X.J00-J06.J03 Acute tonsillitis

X.J30-J39.J35.0 Chronic tonsillitis

X.J00-J06.J04 Acute laryngitis and tracheitis

X.J10-J18.J15 Bacterial pneumonia, not elsewhere classified

X.J20-J22.J20 Acute bronchitis

X.J40-J47.J42 Chronic bronchitis, unspecified

X.J40-J47.J40 Bronchitis, not specified as acute or chronic

XI.K65-K67.K65.0 Acute peritonitis

XI.K80-K87.K81.1 Chronic cholecystitis

XI.K80-K87.K81.0 Acute cholecystitis

XI.K80-K87.K83.0 Cholangitis

XII.L00-L08.L01 Impetigo

XII.L00-L08.L02 Abscess of skin, boil and carbuncle

XII.L00-L08.L03 Phlegmon

XII.L00-L08.L08.0 Pyoderma

XIII.M00-M03.M00 Pyogenic arthritis

XIII.M86-M90.M86 Osteomyelitis

XIV.N10-N16.N11 Chronic tubulointerstitial nephritis

XIV.N10-N16.N10 Acute tubulointerstitial nephritis

XIV.N30-N39.N30 Cystitis

XIV.N30-N39.N34 Urethritis and urethral syndrome

XIV.N40-N51.N41 Inflammatory diseases of the prostate

XIV.N70-N77.N70 Salpingitis and oophoritis

XIV.N70-N77.N71.0 Acute inflammatory disease of the uterus

XIV.N70-N77.N72 Inflammatory disease of the cervix

XIV.N70-N77.N73.0 Acute parametritis and pelvic cellulite

Contraindications:

Individual intolerance of β-lactam antibiotics: penicillins and cephalosporins, neonatal period.

Carefully:

Imbalance of electrolytes or fluids, severe liver damage, colitis in history.

Pregnancy and lactation:

Recommendations for FDA - Category B. It is used in pregnancy and lactation.

Dosing and Administration:

Use in children

Intramuscularly, from the age of two months with a body weight of up to 40 kg - 50 mg / kg every 12 hours, with severe infections - every 8 hours.

Adults

Intravenously slowly or intramuscularly, intraglutally, 0.5-1 g (in severe infections - 2 g) every 12 hours, with severe disease - every 8 hours.

The highest daily dose: 4 g.

The highest single dose: 2 g.

Side effects:

Central and peripheral nervous system: headache, asthenia, paresthesia, confusion, hallucinations (with inflammatory phenomena of the meninges), rarely - convulsions.

Respiratory system: cough.

Hemopoietic system: thrombocytopenia, eosinophilia, leukopenia, an increase in prothrombin index and coagulation time.

Digestive system: nausea, vomiting, diarrhea, increased activity of hepatic enzymes, hepatic or cholestatic jaundice, intestinal dysbacteriosis.

Dermatological reactions: local reactions - compaction at the injection site, candidiasis dermatitis, vulvovaginitis.

urinary system: rarely - the development of hypokalemia.

Allergic reactions.

Overdose:

Nausea, vomiting, diarrhea, neuromuscular excitability, encephalopathy, convulsive attacks.

Treatment is symptomatic, hemodialysis.

Interaction:

Increases the nephro- and ototoxicity of aminoglycosides, furosemide and other loop diuretics.

Simultaneous application with probenecid slows the renal excretion of cefepime.

"Loop diuretics" block the tubular secretion of cefepime.

Special instructions:

Simultaneous use with ethanol can cause a disulfiram-like reaction.

Instructions

Cefepim (Cefepimum)