Cefipime + Sulbactam
Indications
Cefipime + Sulbactam is used for:
Complicated & uncomplicated UTI, moderate to severe pneumonia, complicated intra abdominal infections, febrile neutropenia, serious skin & skin structure infections, bacterial septicemia, post operative infections.
Adult Dose
Parenteral
Adult: Mild to moderate infections: 1-2 g daily in 2 divided doses.
Severe infections: Up to 4 g daily in 2 divided doses.
Child Dose
Renal Dose
Administration
Doses are given by deep IM inj or IV infusion over at least 30 min.
Contra Indications
Hypersensitivity
Precautions
Hypersensitivity to penicillins or other beta-lactam antibiotics. Patient w/ history of seizure disorder, history of GI disease, particularly colitis. Renal impairment. Pregnancy and lactation. Prolonged use may result in overgrowth of non-susceptible organisms. Monitoring Parameters Monitor renal function; signs and symptoms of anaphylaxis during 1st dose.
Pregnancy-Lactation
Interactions
Increased potential for nephrotoxicity and ototoxicity of aminoglycosides. Increased risk of nephrotoxicity w/ potent diuretics (e.g. furosemide).
Adverse Effects
Side effects of Cefipime + Sulbactam :
Headache, rash, diarrhoea, nausea, vomiting, local reactions (e.g. phlebitis, pain and/or inflammation), neutropenia, positive direct Coombs' test.
Potentially Fatal: Neurotoxicity (e.g. encephalopathy, myoclonus, seizures, non-convulsive status epilepticus); Clostridium difficile-associated diarrhoea; anaphylaxis.
Mechanism of Action
Cefepime inhibits bacterial cell wall synthesis by binding to 1 or more of the penicillin-binding proteins (PBPs) which in turn inhibit the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysis and murein hydrolases) while cell wall assembly is arrested.
Sulbactam is an irreversible beta-lactamase inhibitor which binds the ß-lactamase enzyme and does not allow it to interact with the antibiotic, thus extending their spectrum of activity.