Cefepime !

A fourth-generation intravenous cephalosporin covering Pseudomonas and gram-positives; used in febrile neutropenia and hospital pneumonia.

Updated 2026-11-01

Class: Beta-lactams
Enzyme: Penicillin-binding proteins (bacterial transpeptidases)
ATC code: J01DE01

Penicillin-binding proteins (bacterial transpeptidases)Cefepime

The figure shows Streptococcus pneumoniae PBP2x with cefepime in the active site.

Target in 3D: Penicillin-binding proteins (bacterial transpeptidases). PDB structure 5OJ0 (RCSB PDB, public domain). View the structure at RCSB PDB

Mechanism of action

Cefepime acylates the PBPs. It crosses the gram-negative outer membrane well and is more stable to chromosomal (AmpC) β-lactamases, which makes it useful against Enterobacter and Pseudomonas aeruginosa. Unlike ceftazidime, it keeps good activity against streptococci, including pneumococci with reduced penicillin susceptibility, and methicillin-susceptible S. aureus.

Crosses the gram-negative outer membrane
Is more stable to chromosomal β-lactamases
Acylates the PBPs of gram-negatives and gram-positives
Wall synthesis stops and the bacterium lyses

Pharmacokinetics

Absorption: Intravenous or intramuscular.
Elimination: Mainly by the kidney, unchanged; adjusted in kidney failure and removed by haemodialysis.
Half-life: About 2 hours with normal kidney function; much longer in patients on haemodialysis.

Indications

Moderate to severe pneumonia, including hospital-acquired. Community-acquired pneumonia →
Empirical treatment of febrile neutropenia.
Complicated urinary tract infections, including pyelonephritis. Acute pyelonephritis →
Complicated intra-abdominal infections, together with metronidazole. Peritonitis →
Uncomplicated skin infections. Cellulitis of the leg →

Adverse effects

Common

Rash, phlebitis
Diarrhoea, nausea
Positive Coombs test, raised transaminases

Contraindications

Immediate hypersensitivity to cefepime, other cephalosporins, penicillins or other β-lactams

Key interactions

Copper-reduction urine glucose tests: May give a false positive; enzymatic methods are used.

What is monitored

Creatinine and dose adjustment to kidney function
Neurological status: level of consciousness, myoclonus
Electroencephalogram if unexplained encephalopathy appears

Administration and safety

Intravenous infusion, or intramuscular for some indications.
The dose depends on kidney function: confirm creatinine before the first dose and in the following days.
Do not confuse cefepime with cefotaxime, ceftazidime or cefoxitin.

Nursing care

Before the first dose: ask about allergy to penicillins, cephalosporins and other β-lactams, and what the reaction was.
Watch for changes in mental status, tremor, myoclonus or seizures, especially in older adults and kidney disease; report at once.
Monitor urine output and creatinine.
Teach the patient to report watery or bloody diarrhoea, even weeks after the course ends.

Pregnancy and breastfeeding

Available data do not show a higher risk of birth defects; it is used in pregnancy when the infection requires it.

Test yourself

Think of the answer, then tap the question to see it.

What advantage does cefepime have over ceftazidime?

It keeps good activity against gram-positives (streptococci, susceptible S. aureus) and is more stable to chromosomal β-lactamases, useful against Enterobacter.

What is cefepime's most feared adverse effect, and in whom does it occur?

Neurotoxicity (encephalopathy, myoclonus, seizures, non-convulsive status epilepticus), mostly in kidney failure with unadjusted doses.

In which haematology-oncology situation is cefepime used empirically?

In febrile neutropenia, for its broad spectrum that includes Pseudomonas.

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: Cefepime Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); DailyMed - CEFEPIME- cefepime hydrochloride injection, powder, for solution (DailyMed (U.S. National Library of Medicine), 2026); RCSB PDB - 5OJ0: Penicillin-Binding Protein 2X (PBP2X) from Streptococcus pneumoniae in complex with Cefepime (RCSB Protein Data Bank, 2026); Farmacología básica y clínica (Katzung), cap. 43 (McGraw Hill, 2025).

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Representative model, for educational purposes only.