Cefepime (Maxipime) is a powerful, broad-spectrum intravenous antibiotic commonly used in the inpatient and intensive care unit (ICU) settings to treat a myriad of infections. As a fourth generation cephalosporin, cefepime covers many gram positive and gram negative organisms (including Pseudomonas). As an intensivist, I use this antibiotic for everything from hospital acquired pneumonia and complicated urinary infections to empiric coverage for neutropenic fever.

During my ICU fellowship, there were several instances where I encountered cefepime-related encephalopathy. Unlike more clear-cut drug-related side effects, this is a diagnosis of exclusion that can be confounded by the clinical situation itself (ie, overwhelming sepsis can certainly cause altered mentation). Nevertheless, it’s prudent to always consider narrowing a patient’s antibiotic regimen when appropriate!

It’s important to understand that cefepime does not provide coverage for methicillin resistant Staphylococcus aureus (MRSA), Enterococci, and anaerobic organisms. This is why I often combine it with vancomycin (covers MRSA) and metronidazole (covers anaerobes) or replace cefepime with agents like meropenem or pipercillin/tazobactam.

Drop me a comment below with questions! 🙂

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