Cefepime microbiologic profile and update

Background. The evolution of the cephalosporin class of antibiotics through modifications of the basic cephem structure has resulted in a new generation with improved antibacterial activity. Cefepime is a prototypic agent of this new class of fourth generation cephalosporins. Objective. To review the microbiologic profile of cefepime. Results. Cefepime, which is a zwitterion, has a net neutral charge that allows it to penetrate the outer membrane of Gram-negative bacteria faster than third generation cephalosporins. It is more stable against beta-lactamases because of the lower affinity of the enzymes for cefepime when compared with third generation cephalosporins. As a result of these structural attributes, cefepime has in vitro activity against pathogens that are prevalent in pediatric infections. This agent offers the advantage of Gram-positive coverage similar to that of cefotaxime and ceftriaxone, as well as good activity against Pseudomonas aeruginosa and many enteric bacilli that are resistant to third generation cephalosporins, including clinical isolates of Enterobacter spp. and Citrobacter freundii. Conclusions. Based on its spectrum of activity cefepime is an option for the treatment of pediatric infections caused by susceptible pathogens.