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Exblifep
cefepime/ enmetazobactam
Adult Dosing .
Dosage forms: INJ
Special Note
- [strength clarification]
- Info: doses expressed as total cefepime + enmetazobactam amt; 2.5 g cefepime/enmetazobactam contains 2 g cefepime + 0.5 g enmetazobactam
UTI, complicated
- [2.5 g IV q8h x7 days]
- Info: may give up to 14 days if concurrent bacteremia
renal dosing
- [see below]
- eGFR >130: 2.5 g q8h infused over 4h; eGFR 60-129: 2.5 g q8h infused over 2h; eGFR 30-59: 1.25 g q8h infused over 2h; eGFR 15-29: 1.25 g q12h infused over 2h; eGFR <15: 1.25 g x1, then 0.625 g q24h infused over 2h
- HD: 1.25 g x1, then 0.625 g q24h infused over 2h, on dialysis days administer after dialysis; consider supplement if next maintenance dose not due right after dialysis; PD: not defined
hepatic dosing
- [no adjustment]
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- caution: hypersensitivity to beta-lactams
- caution: renal impairment
- caution: eGFR >130
- caution: abx-associated colitis history, recent
Drug Interactions .
Overview
cefepime
cephalosporin
- alters GI flora
- anticoagulant effects
- bactericidal activity requires bacterial growth
- impairs immunomodulatory bacterial infective agent
- lowers seizure threshold
- nephrotoxicity
enmetazobactam
beta-lactamase inhibitor
-
None
Avoid/Use Alternative
- aldesleukin
- amifampridine
- BCG live intravesical
- bumetanide
- cholera vaccine, live
- fecal microbiota, live
- iohexol
- methotrexate
- typhoid vaccine, live
Monitor/Modify Tx
- alteplase
- amikacin
- amikacin inhaled
- antithrombin
- apixaban
- argatroban
- bivalirudin
- bupropion
- dabigatran
- dalteparin
- defibrotide
- edoxaban
- enoxaparin
- ethacrynic acid
- fondaparinux
- furosemide
- gentamicin
- heparin
- iopamidol
- mycophenolate mofetil
- mycophenolic acid
- neomycin
- paromomycin
- plazomicin
- reteplase
- rifampin
- rivaroxaban
- streptomycin
- tenecteplase
- tobramycin
- tobramycin inhaled
- torsemide
- warfarin
Caution Advised
- acetazolamide
- brivaracetam
- busulfan
- cannabidiol
- carbamazepine
- cenobamate
- chlorambucil
- clobazam
- clomipramine
- clonazepam
- clorazepate
- clozapine
- demeclocycline
- diazepam
- doxycycline
- eravacycline
- eslicarbazepine acetate
- ethosuximide
- felbamate
- fenfluramine
- fosphenytoin
- gabapentin
- ganaxolone
- hydroxychloroquine
- lacosamide
- lactulose
- lamotrigine
- levetiracetam
- lorazepam
- magnesium citrate
- methsuximide
- midazolam
- minocycline
- oxcarbazepine
- perampanel
- phenobarbital
- phenytoin
- polyethylene glycol
- polyethylene glycol/electrolytes
- pregabalin
- primidone
- promethazine
- rufinamide
- sarecycline
- sodium picosulfate
- stiripentol
- sulfate bowel prep
- tetracycline
- tiagabine
- topiramate
- tramadol
- treosulfan
- valproic acid
- vigabatrin
- zonisamide
Adverse Reactions .
Serious Reactions
- hypersensitivity reaction
- anaphylaxis
- skin reaction, severe
- interstitial nephritis
- leukopenia
- thrombocytopenia
- encephalopathy
- seizures
- C. difficile-associated diarrhea
Common Reactions
- ALT or AST incr.
- bilirubin incr.
- headache
- infusion site reaction
- diarrhea
- anemia
- vomiting
Safety/Monitoring .
Monitoring Parameters
Cr at baseline; CBC, LFTs if prolonged tx
Pregnancy/Lactation .
Pregnancy
Clinical Summary
cefepime: may use during pregnancy; no human data available, though no known risk of fetal harm based on human data w/ other cephalosporins; no known risk of teratogenicity based on animal data at up to 4x MRHD
enmetazobactam: weigh risk/benefit during pregnancy; no human data available; no known risk of teratogenicity, though possible risk of decr. fetal wt based on animal data at 7x and 11x recommended human dose
Lactation
Clinical Summary
cefepime: may use while breastfeeding; no known risk of infant harm based on limited human data and drug properties; no human data available to assess effects on milk production
enmetazobactam: weigh risk/benefit while breastfeeding; no human data available to assess risk of infant harm or effects on milk production
Pharmacology .
Metabolism: for cefepime: minimal; CYP450: unknown; for enmetazobactam: minimal; CYP450: unknown
Excretion: for cefepime: urine primarily (85% unchanged); Half-life: 2.7h; for enmetazobactam: urine primarily (90% unchanged); Half-life: 2.6h
Subclass: Beta-Lactamase Inhibitors ; Beta-Lactams ; Cephalosporins, 4th generation
Mechanism of Action
for cefepime: binds to peptidoglycan, inhibiting cell wall synthesis; for enmetazobactam: inhibits beta-lactamases, preventing beta-lactam degradation
Formulary .
No Formulary Selected
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