Is it time to revisit cefepime?

We have recently done a small survey of peoples preferences for the therapy of AmpC – producing E. coli and below are the results. If you would like to take the survey click http://viha.fluidsurveys.com/s/UTI-Case-1/

Not long ago serious infections with E.coli and K. pneumoniae were treatable with a wide variety of antibiotics. The evolution of ESBL and AmpC producing strains has changed things. Now it is common in Canada to see infections with strains that are resistant to all of the “workhorse” hospital antibiotics (ceftriaxone, piperacillin-tazobactam, ciprofloxacin) making carbapenems the primary agents. Carbapenem use is rising and carbapenemase producing organisms are appearing on our shores – a very large concern.

Cefepime first became available in 1994 and was marketed as the first “4th generation” cephalosporin with a spectrum of activity similar to ceftazidime but with standard Q12H dosing. It is approved for the treatment of pneumonia, urinary tract infections, skin and soft-tissue infections, intra-abdominal infections and febrile neutropenia. Despite its broad label indications it has never been used widely in Canada. On the current BC provincial hospital formulary it is restricted to febrile neutropenia and cystic fibrosis.

Cefepime is the cephalosporin that is most stable to AmpC beta-lactamases of chromosomal or plasmid origin. There is growing clinical evidence of efficacy even in the context of hyperproduction of AmpC enzymes See http://cid.oxfordjournals.org/content/57/6/781.

With the only alternative therapy often being carbapenems, cefepime is being advocated as a “carbapenem-sparing” strategy for SPICE organism and AmpC E.coli, K. pneumonia and P. mirabilis infections.

It may be time to utilize cefepime more fully in BC.