[Cefepime (maxipime), large spectrum 4th generation cephalosporin, resistant to beta-lactamases]

Abstract

As a result of the appearance of bacterial strains resistant to 3rd generation cephlosporin, since 1993 cephalosporins of 4th generation have been developed and introduced in therapy; among them are: cefepime and cefpirome. Cefepime is the most active 4th generation cephalosporin possessing the following advantages over the 3rd generation cephalosporins: high intrinsic potency due to rapid penetration into the periplasmic space; an extended spectrum of activity that includes many Gram-positive and Gram-negative organisms; Activity against multi-resistant Gram-negative bacteria, including Enterobacter and Klebsiella species; Low potential for beta-lactamase induction, especially Bush group 1 beta-lactamases, even ar low periplasmic concentrations; Minimal selection of resistant mutant strains. Its spectrum is very large being very active against Gram-negative bacilii: Enterobacter, Pseudomonas aeruginosa, Klebsiella pneumoniae, Serratia, Citrobacter, Proteus mirabilis and less active against Bacillus fragillis. Cefepime is also very active against Gram-positive cocci: Staphylococcus aureus (methicillin-susceptible strains only), Streptococcus pneumoniae, Streptococcus pyogenes. Some of the methicillin-resistant strains of staphylococcus are susceptible to cefepime; Enterococcus is resistant. Due to its high resistance against beta-lactamases Cefepime (Maxipime) is the best choice in life threatening nosocomial infections occuring in patients in the intensive care units. Cefepime can be synergically associated with aminoglycosides and fluoroquinolones.