[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Beta-lactams](https://durgical.com/en/pharmacology/classes/beta-lactams/) › Cefepime

[Pharmacology](https://durgical.com/en/pharmacology/) · [Beta-lactams](https://durgical.com/en/pharmacology/classes/beta-lactams/)

# 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](https://durgical.com/en/pharmacology/classes/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](https://www.rcsb.org/structure/5OJ0) · Drag to rotate · pinch to zoom

## 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 →](https://durgical.com/en/conditions/community-acquired-pneumonia/)
- Empirical treatment of febrile neutropenia.
- Complicated urinary tract infections, including pyelonephritis. [Acute pyelonephritis →](https://durgical.com/en/conditions/acute-pyelonephritis/)
- Complicated intra-abdominal infections, together with metronidazole. [Peritonitis →](https://durgical.com/en/conditions/peritonitis/)
- Uncomplicated skin infections. [Cellulitis of the leg →](https://durgical.com/en/conditions/cellulitis-of-the-leg/)

## Adverse effects

### Common

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

### Serious (rare, important)

- Severe, sometimes fatal neurotoxicity (encephalopathy, myoclonus, seizures, non-convulsive status epilepticus), mainly with kidney failure and unadjusted doses
- Anaphylaxis
- Clostridioides difficile diarrhoea, from mild to severe colitis

## 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.

## Memory aid

'Cefepime, fourth = four corners': covers gram-positives and Pseudomonas; but if the kidneys fail, the fourth corner is the brain (encephalopathy).

## 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.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/cefepime/)

## Related drugs

- [Ceftazidime](https://durgical.com/en/pharmacology/ceftazidime/)
- [Piperacillin + tazobactam](https://durgical.com/en/pharmacology/piperacillin-tazobactam/)
- [Ceftriaxone](https://durgical.com/en/pharmacology/ceftriaxone/)

## Related conditions

- [Community-acquired pneumonia](https://durgical.com/en/conditions/community-acquired-pneumonia/)
- [Acute pyelonephritis](https://durgical.com/en/conditions/acute-pyelonephritis/)
- [Peritonitis](https://durgical.com/en/conditions/peritonitis/)
- [Cellulitis of the leg](https://durgical.com/en/conditions/cellulitis-of-the-leg/)

[← Back to the class: Beta-lactams](https://durgical.com/en/pharmacology/classes/beta-lactams/)

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](https://medlineplus.gov/druginfo/meds/a698021.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [DailyMed - CEFEPIME- cefepime hydrochloride injection, powder, for solution](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=de477f37-40f6-4295-ae72-a2ee36a8922e) (DailyMed (U.S. National Library of Medicine), 2026); [RCSB PDB - 5OJ0: Penicillin-Binding Protein 2X (PBP2X) from Streptococcus pneumoniae in complex with Cefepime](https://www.rcsb.org/structure/5OJ0) (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.

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