頭孢吡肟
Cefepime
Cefepime hydrochloride
別名: Maxipime · Axepime · Biopime · Cefepen · Ceficad · Cemax · Cepimix · Forpar · Maxcef · Maxil · BMY-28142 · cefepimi · cefepima
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
各物種劑量
🌎 NA — North America🌍 EU — Europe
狗
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| For susceptible infections | 40 mg/kg IV q6h | IV | q6h | — | 🌎 NA |
馬
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
概覽
頭孢吡肟是一種第四代頭孢菌素抗生素，對革蘭氏陽性及革蘭氏陰性病原體均具有廣泛的抗菌活性。
- 結構優勢： 具有兩性離子結構（淨電荷為中性），使其能迅速穿透革蘭氏陰性菌的外膜孔蛋白。
- β-內醯胺酶穩定性： 對許多β-內醯胺酶（包括AmpC β-內醯胺酶）具有高度抗水解能力，且不易誘導其產生。
- 抗菌譜： 對綠膿桿菌（Pseudomonas aeruginosa）和腸桿菌科（Enterobacteriaceae）具有優異的覆蓋率（類似於頭孢他啶等第三代藥物），同時保留對葡萄球菌和鏈球菌等革蘭氏陽性需氧菌的強大活性。
臨床要點： 由於成本高昂、無口服劑型且需要頻繁給藥（半衰期短），頭孢吡肟通常保留用於重症住院病患（如新生馬駒或敗血症犬隻），特別是在懷疑有多重抗藥性感染，且其他β-內醯胺類、氨基醣苷類或氟喹諾酮類藥物無效或有禁忌症時使用。
作用機制
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.
安全性與警告
禁忌症
- Hypersensitivity to cefepime or other cephalosporins
- Caution in patients with severe renal impairment (dosage adjustment required)
不良反應
- Loose stools or diarrhea
- Pain on IM injection
- Injection site inflammation
- Hypersensitivity reactions (rash, anaphylaxis)
- Neurologic effects (encephalopathy, seizures) in patients with renal dysfunction
注意事項
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.
藥物相互作用
Potential for increased risk of nephrotoxicity; monitor renal function closely.
監測
- Clinical efficacy (resolution of infection signs)
- Renal function (especially in patients with pre-existing renal insufficiency or when used concurrently with nephrotoxic drugs)
藥物動力學
半衰期
吸收
Not absorbed from the GI tract; must be administered parenterally.
分佈
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.
代謝
Minimal hepatic metabolism; less than 1% is metabolized in humans.
排除
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.
過量
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.
可用產品
劑型
- Powder for injection
- Injection solution
人用標示
- 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
各地核准狀態
暫無法規資料: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
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.
飼主須知
重要提示： 本藥物為注射型抗生素，專門用於嚴重感染，且僅能由獸醫專業人員給藥。
- 需要住院： 由於頭孢吡肟需要頻繁靜脈注射（每 6 至 8 小時一次）以維持療效，因此最適合在醫院環境中對住院病患給藥。
- 副作用： 最常見的副作用是輕微的腸胃不適，如軟便或腹瀉。如果您的寵物出現嚴重或帶血的腹瀉，請立即通知您的獸醫師。
- 哺乳期寵物： 藥物會以極低濃度進入母乳。雖然通常認為是安全的，但可能會改變哺乳幼崽的腸道菌群，進而可能引起腹瀉。
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