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Cefepime is a fourth-generation cephalosporin antibiotic. Cefepime has an extended spectrum of activity against Gram-positive and Gram-negative bacteria, with greater activity against both types of organism than third-generation agents.

A 2007 meta-analysis suggested when data of trials were combined, mortality was increased in people treated with cefepime compared with other β-lactam antibiotics.^[1] In response, the U.S. Food and Drug Administration performed their own meta-analysis which found no mortality difference.^[2]

Cefepime was developed by Bristol-Myers Squibb^[3]^[4] and marketed beginning in 1994. It is now available as a generic drug and sold under a variety of trade names worldwide.

Medical use

Cefepime is usually reserved to treat moderate to severe nosocomial pneumonia, infections caused by multiple drug-resistant microorganisms (e.g. Pseudomonas aeruginosa) and empirical treatment of febrile neutropenia.^[5]

Cefepime has good activity against important pathogens including Pseudomonas aeruginosa, Staphylococcus aureus, and multiple drug-resistant Streptococcus pneumoniae. A particular strength is its activity against Enterobacteriaceae. Whereas other cephalosporins are degraded by many plasmid- and chromosome-mediated beta-lactamases, cefepime is stable and is a front-line agent when infection with Enterobacteriaceae is known or suspected.

Spectrum of bacterial susceptibility

Cefepime is a broad-spectrum cephalosporin antibiotic and has been used to treat bacteria responsible for causing pneumonia and infections of the skin and urinary tract. Some of these bacteria include Pseudomonas, Escherichia, and Streptococcus species. The following represents MIC susceptibility data for a few medically significant microorganisms.

Escherichia coli: ≤0.007 – 128 μg/ml
Pseudomonas aeruginosa: 0.06 – >256 μg/ml
Streptococcus pneumoniae: ≤0.007 – >8 μg/ml

^[6]

Chemistry

The combination of the syn-configuration of the methoxyimino moiety and the aminothiazolyl moiety confers extra stability to β-lactamase enzymes produced by many bacteria. The N-methylpyrrolidine moiety increases penetration into Gram-negative bacteria. These factors increase the activity of cefepime against otherwise resistant organisms including Pseudomonas aeruginosa and Staphylococcus aureus.

Trade names

Following expiration of the Bristol-Myers Squibb patent, cefepime became available as a generic and is now marketed by numerous companies worldwide under tradenames including Neopime (Neomed), Maxipime, Cepimax, Cepimex, and Axepim.

References

^ Yahav D, Paul M, Fraser A, Sarid N, Leibovici L (2007). "Efficacy and safety of cefepime: a systematic review and meta-analysis". Lancet Infect Dis. 7 (5): 338–48. doi:10.1016/S1473-3099(07)70109-3. PMID 17448937.
^ "Information for Healthcare Professionals: Cefepime (marketed as Maxipime)". Retrieved 2009-08-02.
^ Barbhaiya RH, Forgue ST, Gleason CR, Knupp CA, Pittman KA, Weidler DJ, Martin RR (1990). "Safety, tolerance, and pharmacokinetic evaluation of cefepime after administration of single intravenous doses". Antimicrob. Agents Chemother. 34 (6): 1118–22. doi:10.1128/aac.34.6.1118. PMC 171768 . PMID 2203303.
^ "www.accessdata.fda.gov" (PDF).
^ Chapman TM, Perry CM (2003). "Cefepime: a review of its use in the management of hospitalized patients with pneumonia". Am J Respir Med. 2 (1): 75–107. doi:10.1007/bf03256641. PMID 14720024.
^ http://www.toku-e.com/Assets/MIC/Cefepime.pdf

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English Journal

The antibiotic cefepime interferes with amino acid analysis by ion-exchange chromatography.

Scott AI1, Mendelsohn BA2, Le A3, Cowan TM3.
Clinica chimica acta; international journal of clinical chemistry.Clin Chim Acta.2016 May 1;456:149-50. doi: 10.1016/j.cca.2016.03.003. Epub 2016 Mar 4.
PMID 26947969

Treatment options for extended-spectrum beta-lactamase (ESBL) and AmpC-producing bacteria.

D'Angelo RG1, Johnson JK2, Bork JT3, Heil EL4.
Expert opinion on pharmacotherapy.Expert Opin Pharmacother.2016 May;17(7):953-67. doi: 10.1517/14656566.2016.1154538. Epub 2016 Mar 3.
INTRODUCTION: Extended spectrum β-lactamases (ESBL) and AmpC β-lactamases are increasing causes of resistance in many Gram-negative pathogens of common infections. This has led to a growing utilization of broad spectrum antibiotics, most predominately the carbapenem agents. As the prevalence of ES
PMID 26891857

Antibiotic resistance profiles of Pseudomonas aeruginosa isolated from various Greek aquatic environments.

Olga P1, Apostolos V2, Alexis G3, George V4, Athena M5.
FEMS microbiology ecology.FEMS Microbiol Ecol.2016 May;92(5). pii: fiw042. doi: 10.1093/femsec/fiw042. Epub 2016 Feb 24.
A large number of antibiotic-resistantP. aeruginosaisolates are continuously discharged into natural water basins mainly through sewage. However, the environmental reservoirs of antibiotic resistance factors are poorly understood. In this study, the antibiotic resistance patterns of 245 isolates fro
PMID 26917780

Japanese Journal

Usefulness of the Final Filter of the IV Infusion Set in Intravenous Administration of Drugs : Contamination of Injection Preparations by Insoluble Microparticles and Its Causes

倉本敬二,東林海徹,仲川善人
藥學雜誌 126(4), 289-295, 2006-04-01
… The test drugs used were Doyle^[○!R] 1g vial, Cefotax^[○!R] 1g vial, Minomycin^[○!R] 100mg vial, Omegacin^[○!R] 0.3g vial, Maxipime^[○!R] 1g vial, Rocephin^[○!R] 1g vial, Isovorin^[○!R] 25mg vial, Diamox^[○!R] 500mg vial and Fungizone^[○!R] 50mg vial. …
NAID 110006154936

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★リンクテーブル★

リンク元	「セフェピム」
関連記事	「maxipime」

「セフェピム」

Cefepime
Clinical data
Pronunciation	/ˈsɛfɪpiːm/ or /ˈkɛfɪpiːm/
Trade names	Maxipime, Voco
AHFS/Drugs.com	Monograph
MedlinePlus	a698021
Pregnancy; category	AU: B1; US: B (No risk in non-human studies); ;
Routes of; administration	Intravenous, intramuscular
ATC code	J01DE01 (WHO);
Legal status
Legal status	AU: S4 (Prescription only); CA: ℞-only; UK: POM (Prescription only); US: ℞-only;
Pharmacokinetic data
Bioavailability	100% (IM)
Metabolism	Hepatic 15%
Biological half-life	2 hours
Excretion	Renal 70–99%
Identifiers
	IUPAC name (6R,7R,Z)-; 7-(2-(2-aminothiazol-4-yl)-2-(methoxyimino)acetamido)-; 3-((1-methylpyrrolidinium-1-yl)methyl)-8-oxo-5-thia-; 1-aza-bicyclo[4.2.0]oct-2-ene-2-carboxylate;
CAS Number	88040-23-7 ;
PubChem CID	5479537;
DrugBank	DB01413 ;
ChemSpider	4586395 ;
UNII	807PW4VQE3;
KEGG	D02376 ;
ChEBI	CHEBI:478164 ;
ChEMBL	CHEMBL186 ;
ECHA InfoCard	100.171.025
Chemical and physical data
Formula	C19H24N6O5S2
Molar mass	480.56 g/mol
3D model (JSmol)	Interactive image;
	SMILES O=C2N1/C(=C(\CS[C@@H]1[C@@H]2NC(=O)C(=N\OC)/c3nc(sc3)N)C[N+]4(C)CCCC4)C([O-])=O ;
	InChI InChI=1S/C19H24N6O5S2/c1-25(5-3-4-6-25)7-10-8-31-17-13(16(27)24(17)14(10)18(28)29)22-15(26)12(23-30-2)11-9-32-19(20)21-11/h9,13,17H,3-8H2,1-2H3,(H3-,20,21,22,26,28,29)/b23-12-/t13-,17-/m1/s1 ; Key:HVFLCNVBZFFHBT-ZKDACBOMSA-N ;
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