Side effects of cefepime

Cefepime (injection)

Generic Name: cefepime (injection) (SEF e peem)
Brand Name: Maxipime, Maxipime ADD-Vantage

Medically reviewed by Drugs.com on Nov 28, 2019 – Written by Cerner Multum

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What is cefepime?

Cefepime is a cephalosporin (SEF a low spor in) antibiotic. It works by fighting bacteria in your body.

Cefepime injection is used to treat many kinds of bacterial infections, including severe or life-threatening forms.

Cefepime may also be used for purposes not listed in this medication guide.

Important Information

You should not use cefepime if you are allergic to certain antibiotics, including cefepime and similar medicines (Keflex, Omnicef, and others), or penicillin antibiotics (amoxicillin, ampicillin, piperacillin, ticarcillin, Augmentin, and others).

Before taking this medicine

You should not use this medicine if you have ever had a severe allergic reaction to cefepime or any other cephalosporin antibiotic, such as:

You should not use cefepime if you are allergic to penicillin antibiotics, including:

  • amoxicillin (Augmentin);

  • ampicillin;

  • piperacillin; or

  • ticarcillin, and others.

To make sure cefepime is safe for you, tell your doctor if you have ever had:

  • an allergic reaction to an antibiotic;

  • an allergy to corn products;

  • kidney disease (or if you are on dialysis);

  • liver disease;

  • a stomach or intestinal disorder such as colitis;

  • diabetes; or

  • if you are malnourished.

Cefepime is not expected to harm an unborn baby. Tell your doctor if you are pregnant.

Cefepime can pass into breast milk, but effects on the nursing baby are not known. Tell your doctor if you are breast-feeding.

Do not give this medicine to a child without medical advice.

How is cefepime given?

Follow all directions on your prescription label. Do not use cefepime in larger or smaller amounts or for longer than recommended.

Cefepime is injected into a vein through an IV. You may be shown how to use an IV at home. Do not give yourself this medicine if you do not understand how to use the injection and properly dispose of needles, IV tubing, and other items used.

Cefepime must be given slowly, and the IV infusion can take about 30 minutes to complete.

You will need to mix cefepime with a liquid (diluent) in an IV bag before using it. If you are using the injections at home, be sure you understand how to properly mix and store the medicine.

After mixing your medicine, you will need to use it within a certain number of hours or days. This will depend on the diluent and how you store the mixture (at room temperature, in a refrigerator, or frozen). Carefully follow the mixing and storage instructions provided with your medicine. Ask your pharmacist if you have questions.

Cefepime may become darker after you have mixed it with a diluent. Do not use the medicine if it has become cloudy or has particles in it. Call your pharmacist for new medication.

Use this medicine for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Cefepime will not treat a viral infection such as the flu or a common cold.

Cefepime can cause false-positive results with certain lab tests for glucose (sugar) in the urine. Tell any doctor who treats you that you are using cefepime.

Store unmixed cefepime at room temperature away from moisture, heat, and light.

Use a disposable needle and syringe only once. Follow any state or local laws about throwing away used needles and syringes. Use a puncture-proof “sharps” disposal container (ask your pharmacist where to get one and how to throw it away). Keep this container out of the reach of children and pets.

What happens if I miss a dose?

Call your doctor for instructions if you miss a dose of cefepime.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while using cefepime?

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.

Cefepime side effects

Get emergency medical help if you have signs of an allergic reaction (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning in your eyes, skin pain, red or purple skin rash that spreads and causes blistering and peeling).

Call your doctor at once if you have:

  • severe stomach pain, diarrhea that is watery or bloody;

  • confusion, hallucinations;

  • trouble speaking, reading, or understanding the words of other people;

  • seizure (blackout or convulsions);

  • problems with hearing; or

  • kidney problems–little or no urination, swelling in your feet or ankles, feeling tired or short of breath.

Common side effects may include:

  • pain, bruising, swelling, or other irritation where the injection was given;

  • nausea, vomiting, diarrhea;

  • headache;

  • fever; or

  • itching, rash.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect cefepime?

Cefepime can harm your kidneys. This effect is increased when you also use certain other medicines, including: antivirals, chemotherapy, injected antibiotics, medicine for bowel disorders, medicine to prevent organ transplant rejection, injectable osteoporosis medication, and some pain or arthritis medicines (including aspirin, Tylenol, Advil, and Aleve).

Tell your doctor about all your current medicines and any you start or stop using, especially:

  • a diuretic or “water pill” such as furosemide.

Other drugs may interact with cefepime, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all your current medicines and any medicine you start or stop using.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2018 Cerner Multum, Inc. Version: 8.01.

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Consumer resources

  • Cefepime
  • Cefepime Injection (Advanced Reading)

Other brands: Maxipime

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Cefepime

Cefepime is the generic form of the brand-name drug Maxipime, which is used to treat bacterial infections such as urinary tract infections, pneumonia, and skin infections.

The prescription medicine is in the cephalosporin class of antibiotics, which work by killing bacteria.

The Food and Drug Administration (FDA) approved cefepime in 1996. It’s manufactured as Maxipime by Hospira.

Cefepime Warnings

Before taking cefepime, tell your doctor if you have, or have ever had:

  • Kidney, liver, or gastrointestinal disease
  • Diabetes
  • Blood clotting problems
  • Allergies to medications (especially antibiotics in the penicillin or cephalosporin family)

If you have kidney problems, your doctor may need to adjust your dose of cefepime to lower your risk of having a seizure.

If you have diabetes, don’t use Clinitest tablets to check for sugar in your urine while taking cefepime. You may get false positive results. Instead, use Clinistix or Tes-Tape.

Cefepime is injected into your vein or skin and may cause a catheter-related infection. Tell your doctor right away if you experience any of the following symptoms near your catheter:

  • Warmth
  • Tenderness
  • Irritation
  • Drainage
  • Redness
  • Pain
  • Swelling

Use cefepime for the entire course of treatment recommended by your doctor. Don’t stop using the drug sooner, even if you feel better.

Long-term use of cefepime may cause a secondary infection. Tell your doctor if you notice signs of another infection.

Mild diarrhea is a common side effect of antibiotics. But in rare cases, these drugs may cause a more serious form of diarrhea known as pseudomembranous colitis. Tell your doctor if you experience:

  • Severe stomach pain or cramps
  • Bloody stools
  • Severe diarrhea

Cefepime only works on bacterial infections. It won’t treat viral infections such as the common cold.

Cefepime may reduce your blood’s ability to clot. Try to avoid activities that can cause bruising or injury while using the drug.

Elderly people may be more sensitive to the side effects of cefepime.

Don’t give cefepime to a child younger than two months old without talking to your doctor. Safety and effectiveness in this age group haven’t been confirmed.

Pregnancy and Cefepime

Cefepime isn’t expected to harm an unborn baby, but tell your doctor if you’re pregnant, or might become pregnant, before taking this medicine.

You’ll need to discuss the risks and benefits of using the medicine during pregnancy.

Cefepime passes into breast milk. Talk to your doctor before breastfeeding while taking this drug.

PRECAUTIONS: Before using cefepime, tell your doctor or pharmacist if you are allergic to it; or to other cephalosporins; or to penicillins; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, stomach/intestinal diseases (e.g., colitis).Kidney function declines as you grow older. This medication is removed by the kidneys. Therefore, elderly people may be at greater risk for side effects while using this drug.Tell your doctor if you are pregnant before using this medication.This medication passes into breast milk and may have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.

DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.Some products that may interact with this drug include: aminoglycoside antibiotics (e.g., tobramycin, gentamicin), chloramphenicol, probenecid, live bacterial vaccines.Although most antibiotics probably do not affect hormonal birth control such as pills, patch, or ring, some antibiotics may decrease their effectiveness. This could cause pregnancy. Examples include rifamycins such as rifampin or rifabutin. Be sure to ask your doctor or pharmacist if you should use additional reliable birth control methods while using this antibiotic.This medication may interfere with certain medical/laboratory tests (e.g., urine glucose tests), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

OVERDOSE: If overdose is suspected, contact a poison control center or emergency room immediately. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: trouble breathing, seizures.

NOTES: Do not share this medication with others.This medication has been prescribed for your current condition only. Do not use it later for another infection unless told to do so by your doctor. A different medication may be necessary in that case.Laboratory and/or medical tests (e.g., complete blood count) may be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

MISSED DOSE: For the best possible benefit, it is important to receive each scheduled dose of this medication as directed. If you miss a dose, contact your doctor or pharmacist immediately to establish a new dosing schedule. Do not double the dose to catch up.

STORAGE: Consult the product instructions and your pharmacist for storage details. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

Information last revised May 2013. Copyright(c) 2013 First Databank, Inc.

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Maxipime

SIDE EFFECTS

The following adverse reactions are discussed in the Warnings and Precautions section and below:

  • Hypersensitivity Reactions
  • Neurotoxicity
  • Clostridium difficile-Associated Diarrhea

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

In clinical trials using multiple doses of cefepime, 4137 patients were treated with the recommended dosages of cefepime (500 mg to 2 g intravenous every 12 hours). There were no deaths or permanent disabilities thought related to drug toxicity. Sixty-four (1.5%) patients discontinued medication due to adverse reactions. Thirty-three (51%) of these 64 patients who discontinued therapy did so because of rash. The percentage of cefepime-treated patients who discontinued study drug because of drug-related adverse reactions was similar at daily doses of 500 mg, 1 g, and 2 g every 12 hours (0.8%, 1.1%, and 2%, respectively). However, the incidence of discontinuation due to rash increased with the higher recommended doses.

The following adverse reactions (Table 5) were identified in clinical trials conducted in North America (n=3125 cefepime-treated patients).

Table 5: Adverse Reactions in Cefepime Multiple-Dose Dosing Regimens Clinical Trials in North America

The following (Table 6) adverse laboratory changes, with cefepime, were seen during clinical trials conducted in North America.

Table 6: Adverse Laboratory Changes in Cefepime Multiple-Dose Dosing Regimens Clinical Trials in North America

A similar safety profile was seen in clinical trials of pediatric patients

Postmarketing Experience

The following adverse reactions have been identified during post-approval use of MAXIPIME. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

In addition to the adverse reactions reported during the North American clinical trials with cefepime, the following adverse reactions have been reported during worldwide postmarketing experience. Encephalopathy (disturbance of consciousness including confusion, hallucinations, stupor, and coma), aphasia, myoclonus, seizures, and nonconvulsive status epilepticus have been reported.

Anaphylaxis including anaphylactic shock, transient leukopenia, neutropenia, agranulocytosis and thrombocytopenia, have been reported.

Cephalosporin-Class Adverse Reactions

In addition to the adverse reactions listed above that have been observed in patients treated with cefepime, the following adverse reactions and altered laboratory tests have been reported for cephalosporin-class antibacterial drugs:

Stevens-Johnson syndrome, erythema multiforme, toxic epidermal necrolysis, renal dysfunction, toxic nephropathy, aplastic anemia, hemolytic anemia, hemorrhage, hepatic dysfunction including cholestasis, and pancytopenia.

Read the entire FDA prescribing information for Maxipime (Cefepime Hydrochloride for Injection)

PMC

Case report.

A 25-year-old man suffering from meningoencephalitis was admitted to the Patras University Hospital intensive care unit (ICU) due to the acute appearance of seizures and cardiac arrest. During his 1-month hospitalization in the ICU he acquired nosocomial infections, such as venous catheter and respiratory infections, which were treated with various antibiotics. During his recovery period in the internal medicine department, he developed intense pruritus and an erythematous-fine maculopapular rash covering the neck and upper torso 30 min after intravenous cefepime infusion (Fig. 1), without any local infusion site erythema; this reaction appeared on the twelfth day of cefepime administration (2 g over 30 min, three times daily) as part of the treatment regimen. Other symptoms, such as dyspnea, tachycardia, and hypotension, were not present. The patient’s reaction was completely relieved by intravenous antihistamine administration (dimetindene; 0.1 mg/kg). Given the temporal association of this reaction with cefepime infusion (Table 1), the antibiotic was suspected as the underlying cause. In order to assess this hypothesis, administration of all other antibiotics was suspended while we rechallenged him with intravenous cefepime (alone) 8 h later; the same symptoms reappeared and then quickly resolved after the administration of intravenous dimetindene. Thus, we concluded that the observed reaction was an adverse effect induced by cefepime. The patient did not report any history of drug allergy or atopic disease.

Cefepime-induced red man syndrome in a 25-year-old male.

Table 1

Drug administration times, prior to reaction-inducing infusions of cefepime

ai.v., intravenous; p.o., per os; s.c., subcutaneous. bInitial reaction-associated infusion. cDrug rechallenge infusion.

The adverse effect of cefepime observed in this patient corresponds to red man syndrome, a combination of pruritic erythematous rash (affecting the face, neck, and upper torso) and possible anaphylaxoid symptoms, classically associated with vancomycin infusion (9). A few cases have also been reported following administration of infliximab (2), teicoplanin, and amphotericin B but not cefepime (9). The reaction observed in our patient occurred 5 days after the last dose of vancomycin (per os) was administered for suspected Clostridium difficile colitis, making any contribution of this antibiotic to the adverse event described exceptionally implausible.

Vancomycin-related red man syndrome is usually associated with a high infusion rate and appears soon after the initiation of infusion; however, it has been observed with lower infusion rates and following several days of treatment as well (9). Correspondingly, our patient presented this adverse reaction shortly after high-dose cefepime infusion but was asymptomatic during the first 12 days of treatment.

The underlying mechanism of red man syndrome has been found to be IgE-independent degranulation of mast cells brought about by vancomycin, with mast cell-derived histamine being a significant mediator of the observed adverse effect (11). As a result, the established effectiveness of antihistamines in the prevention and treatment of red man syndrome (7), as observed in our patient, is not surprising.

Unlike our description of cefepime-related red man syndrome, two cases of IgE-mediated anaphylaxis with prominent angioedema, airway compromise, and/or circulatory symptoms following cefepime were previously reported (4, 6).

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