Cefepime
Cefepime hydrochloride
Also known as: Maxipime · Axepime · Biopime · Cefepen · Ceficad · Cemax · Cepimix · Forpar · Maxcef · Maxil · BMY-28142 · cefepimi · cefepima
Reviewed by the VetSheet Veterinary TeamUpdated Apr 5, 2026Evidence-based veterinary reference
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Dosing by species
🌎 NA — North America🌍 EU — Europe
Dogs
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| For susceptible infections | 40 mg/kg IV q6h | IV | q6h | — | 🌎 NA |
Horses
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| For susceptible infections in foals (gram-negative infections) | 11 mg/kg IV q8h | IV | q8h | — | 🌎 NA |
| Neonates with poor aminoglycoside kinetics or documented multi-resistant infections | 11 mg/kg IV q8h | IV | q8h | — | 🌎 NA |
- Neonates with poor aminoglycoside kinetics or documented multi-resistant infections: Use has been limited primarily to neonates
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Overview
Cefepime is a 4th-generation cephalosporin antibiotic with a broad spectrum of activity against both gram-positive and gram-negative pathogens.
- Structural Advantage: It possesses a zwitterionic structure (having a net neutral charge), which allows it to rapidly penetrate the outer membrane porins of gram-negative bacteria.
- Beta-Lactamase Stability: It is highly resistant to hydrolysis by many beta-lactamases, including AmpC beta-lactamases, and does not readily induce their production.
- Spectrum: It offers excellent coverage against Pseudomonas aeruginosa and Enterobacteriaceae (similar to 3rd-generation agents like ceftazidime) while retaining robust activity against gram-positive aerobes like Staphylococcus and Streptococcus species.
Clinical Pearl: Due to its high cost, lack of oral formulation, and requirement for frequent dosing (short half-life), cefepime is typically reserved for critically ill hospitalized patients (such as neonatal foals or dogs with sepsis) where multi-drug resistant infections are suspected and other beta-lactams, aminoglycosides, or fluoroquinolones are ineffective or contraindicated.
Mechanism of action
Cefepime is a bactericidal, time-dependent antibiotic that works by disrupting bacterial cell wall synthesis.
- Target Binding: It rapidly penetrates the bacterial cell envelope and binds with high affinity to specific penicillin-binding proteins (PBPs), primarily PBP 3 and PBP 2.
- Inhibition: Binding to PBPs inhibits the transpeptidation enzyme responsible for cross-linking peptidoglycan strands.
- Cell Lysis: The lack of a structurally sound cell wall → activation of bacterial autolysins → osmotic cell lysis and bacterial death.
Safety & warnings
Contraindications
- Hypersensitivity to cefepime or other cephalosporins
- Caution in patients with severe renal impairment (dosage adjustment required)
Adverse effects
- Loose stools or diarrhea
- Pain on IM injection
- Injection site inflammation
- Hypersensitivity reactions (rash, anaphylaxis)
- Neurologic effects (encephalopathy, seizures) in patients with renal dysfunction
Precautions
Dosage adjustment is recommended in patients with severe renal impairment to prevent neurotoxicity. May cause false-positive urine glucose determinations when using the copper reduction method (e.g., Clinitest). May cause a false-positive direct Coombs' test, particularly in azotemic patients. IM injections can be painful; 1% lidocaine may be used as a diluent to alleviate pain.
Drug interactions
Potential for increased risk of nephrotoxicity; monitor renal function closely.
Monitoring
- Clinical efficacy (resolution of infection signs)
- Renal function (especially in patients with pre-existing renal insufficiency or when used concurrently with nephrotoxic drugs)
Pharmacokinetics
Half-life
Absorption
Not absorbed from the GI tract; must be administered parenterally.
Distribution
Volume of distribution at steady state (Vdss) is approximately 0.14 L/kg in dogs and 0.18 L/kg in neonatal foals. In humans, about 20% is bound to plasma proteins.
Metabolism
Minimal hepatic metabolism; less than 1% is metabolized in humans.
Elimination
Primarily excreted unchanged into the urine (approximately 85% in humans). Clearance is 0.13 L/kg/hr in dogs and 0.08 L/kg/hr in neonatal foals.
Overdose
No specific information is available for acute toxicity in veterinary patients. In humans with impaired renal function, inadvertent overdoses have led to encephalopathy, seizures, and neuromuscular excitability. Treatment should be supportive, and renal function must be monitored.
Available products
Formulations
- Powder for injection
- Injection solution
Human-labeled
- Cefepime Powder for Injection: 500 mg, 1 gram & 2 gram in vials, 15 mL & 20 mL vials, ADD-Vantage vials, & 100 mL piggyback bottles
- Cefepime Injection Solution: 1 g & 2 g in 50 mL & 100 mL single-dose Galaxy containers
Regulatory status
No regulatory data for: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Storage & stability
Store powder for injection between 2-25°C and protect from light. Reconstituted solutions (with normal saline or D5W) are generally stable for up to 24 hours at room temperature, or up to 7 days if kept refrigerated.
Client information
Important: This medication is an injectable antibiotic reserved for serious infections and is administered exclusively by veterinary professionals.
- Hospitalization Required: Because cefepime requires frequent intravenous dosing (every 6 to 8 hours) to remain effective, it is best administered to inpatients in a hospital setting.
- Side Effects: The most common side effect is mild gastrointestinal upset, such as loose stools or diarrhea. If your pet develops severe or bloody diarrhea, notify your veterinarian immediately.
- Nursing Pets: It passes into maternal milk in very low concentrations. While generally considered safe, it may alter the gut flora of nursing offspring, potentially causing diarrhea.
VetSheet drug reference is intended for licensed veterinary professionals as a clinical decision-support aid, not a substitute for professional judgement or the manufacturer’s current label.