Cefepime and Ceftriaxone: comparison, which is better in general and for pneumonia, differences

When choosing between Cefepime and Ceftriaxone, take into account that the first drug is stronger, especially for infections caused by Pseudomonas aeruginosa or Enterobacteriaceae. It is used in cases of ineffectiveness of cephalosporins, including Ceftriaxone, and severe purulent-inflammatory diseases.

The second antibiotic has advantages for bacterial meningitis in adults, treatment of newborns up to 1 month, and pregnant women. To select the correct antibiotic, it is necessary to do a culture, identify the pathogen and its sensitivity. These drugs should not be used for self-medication, since it is important to know the exact dose and course of administration.

When the doctor is faced with a choice - Cefepime or Ceftriaxone

The need to choose one of the cephalosporin antibiotics - Cefepime or Ceftriaxone - occurs when there is a bacterial infection:

pneumonia;
accumulation of pus in the pleura (empyema);
acute bronchitis or exacerbation of chronic bronchitis with severe course;
complicated forms of inflammation of the urinary tract (purulent urethritis, cystitis, pyelonephritis);
suppuration of the skin and subcutaneous tissue;
inflammation of bone tissue or joints caused by bacteria;
in the abdominal cavity (peritonitis);
inflammatory process in the pelvic organs (severe prostatitis, adnexitis, endometritis);
salmonellosis;
meningitis (inflammation of the vascular membranes of the brain);
blood poisoning (sepsis);
purulent-inflammatory diseases in patients with reduced immunity.

Since both drugs have a wide spectrum of antimicrobial action and only an injection form, they are used for severe or moderate infectious diseases.

Cefepime and Ceftriaxone should not be used without a doctor's prescription, since it is important not only to know the name of the antibiotic, but also to accurately select the dose. If it is lower than necessary, then instead of destroying bacteria, they become resistant to their introduction. When using large quantities and a long course, the risk of complications increases significantly.

We recommend reading about the rules for using Ceftriaxone for pneumonia. From the article you will learn about the mechanism of action of the antibiotic for pneumonia, the course of treatment with Ceftriaxone in children and adults, and what it can be combined with. And here is more information about Ceftriaxone analogues.

Contraindications

General contraindications for these drugs are intolerance to:

active ingredients (cefepime hydrochloride or ceftriaxone), ;
other cephalosporins;
penicillins;
carbapenems (for example, Meronem).

They are used with caution in cases of previously suffered intestinal inflammation after the administration of any antibiotics (drug-induced colitis, dysbacteriosis), lactation, severe kidney failure, liver failure.

Cefepime should not be prescribed to children under 1 month of age, in the first trimester of pregnancy and in individuals with high sensitivity to the amino acid arginine. Ceftriaxone is prohibited for use in newborns under the following conditions:

age up to 41 weeks, including the period of intrauterine development;
increased blood bilirubin, jaundice;
the need for droppers with calcium salts;
a shift in the blood reaction to the acidic side.

Cefepime or Ceftriaxone - which is better?

Cefepime may be better than Ceftriaxone, provided that the infectious agent is:

belongs to the group of gram-negative bacteria;
Pseudomonas aeruginosa;
enterobacteria.

Since it is impossible to determine such properties of a microbe based on clinical signs, a bacteriological study (culture with sensitivity determination) is necessary for the correct choice of antibiotic. In general, Cefepime is considered stronger, and your doctor may recommend it for:

ineffectiveness of other antibacterial agents, including Ceftriaxone;
severe cases of infection;
isolation of several bacteria during culture;
a pronounced decline in immunity, especially a decrease in neutrophils in the blood.

Cefepime belongs to the 4th generation of cephalosporins, and Ceftriaxone belongs to the third. But in terms of basic characteristics they are very similar.

For pneumonia

Cefepime has advantages in the treatment of severe or moderate pneumonia, as well as those caused by:

streptococcus,
Pseudomonas aeruginosa,
klebsiella,
enterobacteria.

It is most often prescribed when bacteria are detected in the blood. In all other cases, as well as in pregnant women and newborns, Ceftriaxone is usually recommended.

Urinary tract infections

Pyelonephritis, cystitis, urethritis with severe and complicated course usually require the use of Cefepime. This drug is also needed for urine culture to detect Escherichia coli, Proteus and Klebsiella. Ceftriaxone is used for moderate inflammation and uncomplicated forms of disease.

Bacterial meningitis

Ceftriaxone has an advantage in the treatment of inflammation of the choroid, especially in adult patients. This is due to the fact that it penetrates well through the blood-brain barrier. In children, any of the drugs can be used.

Resistance problems

Third generation cephalosporins are powerful antibacterial drugs used to treat life-threatening infections. However, in recent years, resistance to these drugs has been increasingly reported, especially among members of Enterobacteriaceae (Kozlov et al., 2008), due to the continued spread of ESBLs. Numerous publications report the widespread spread of antibiotic resistance and the identification of pathogenic microorganisms resistant to all available antibacterial drugs (Bereznyakov, 2006, 2012). Multidrug-resistant (MDR) bacteria are no longer found only in hospitals, but also in community settings. Hydrolysis of blactam antibiotics by blactamases is the main mechanism of resistance to this class of antimicrobial agents in clinically important Gram-negative bacteria.

ESBLs are known to hydrolyze oxyiminocephalosporins (cefotaxime, ceftazidime, ceftriaxone, cefuroxime and cefepime) and monobactams (aztreonam), but not cephamycins (cefoxitin, cefotetan) or carbapenems. ESBLs are usually localized on large plasmids. Although the ability to produce ESBLs has been documented in many members of the family Enterobacteriaceae and P.aeruginosa, at the end of the last century ESBL production was most often observed in Klebsiella spp. In recent years, E. coli has become increasingly important among ESBL producers.

Cefepime and Ceftriaxone: differences

The differences between Cefepime and Ceftriaxone are shown in the table.

Sign	Cefepime	Ceftriaxone
Generation of cephalosporins	Fourth	Third
Effect on gram-positive bacteria	Medium strength	Moderate
Sensitivity of gram-negative microbes	High	Closer to high
Destruction of anaerobes (grow without oxygen)	Moderate	Intensive
Penetration through the blood-brain barrier (from blood to brain)	Average in adults, good in children with inflammation	good
How many times should you inject per day	2-3 times a day	1 time per day
Toxicity	Average	Low
Price 1 bottle of 1 g	120 rubles	30 rubles

Directions for use and doses

Dosages of drugs for adults depend on the diagnosis, the severity of the infection, and in children, weight is also taken into account.

For adults

Ceftriaxone is administered intramuscularly or intravenously 1 g per day once. If 2 g or more is prescribed, the doctor may recommend dividing the daily dose into 2 times or placing an IV with the entire amount of antibiotic. The maximum dosage is 4 g.

Specific treatment options:

before surgery, 1-2 g are administered an hour before the incision;
acute gonorrhea without complications - 250 mg only 1 time;
tick-borne borreliosis (Lyme disease) - 50 mg/kg once a day for 2 weeks;
bacterial meningitis 1-4 g from 4 days to 1.5-2 weeks;
impaired renal function - reduce the maximum dose to 2 g only in extremely severe cases (creatinine clearance up to 10 ml/min).

Cefepime is used in the following quantities:

pneumonia – 1-2 g into a vein 2 times a day for 10 days;
fever with decreased immunity (neutropenia) - 2 g into a vein 3 times a day for a week;
inflammation of the kidneys and urinary tract - intravenously, less often intramuscularly 0.5-2 g twice a day for 1-1.5 weeks;
damage to the skin and soft tissues - intravenously, 2 g 2 times a day for 10 days;
infections in the abdominal cavity - 2 g into a vein every 12 hours for 7-10 days.

For children

Ceftriaxone is administered from birth, but depending on age, the maximum dosage varies:

up to 2 weeks – 20-50 mg per 1 kg of body weight;
from 2 weeks to 12 years – 20-80 mg/kg;
with a weight of 50 kg and after 12 years, adult doses are needed.

The course of treatment is usually 10 days or at least 5, provided that the temperature normalizes 2-3 days after the first injection.

Cefepime is administered at a rate of 50 mg per kg of body weight every 12 hours. If the child’s weight is above 40 kg, age is more than 16 years, and in case of fever due to neutropenia, another injection is added. In such cases, injections are carried out at intervals of 8 hours. The course of treatment is the same as for Ceftriaxone.

Useful video

Watch this video about the indications and contraindications for the use of the drug Cefotaxime, instructions for use:

Rules for preparing injections

To prepare a solution of Ceftriaxone for injection into the muscle, you need to take 4 ml of 1% Lidocaine or 2 ml of water for injection and 2% Lidocaine per 1 g of powder. The solvent is injected into the vial with a syringe and shaken until the solution is completely transparent.

For intravenous injections, 10 ml of saline solution is taken per 1 g of Ceftriaxone. If it is necessary to place a dropper, then 2 g of the medication is dissolved in 40 ml of a calcium-free solution:

0.9% sodium chloride,
5% glucose,
6% Voluven.

For Cefepime, the predominant route of administration is intravenous. For injection, add saline solution or 5% glucose in a volume of 10 ml per 1 g of the drug. If it is necessary to carry out an infusion, then take the resulting antibiotic solution for a dropper and adjust the amount of solvent to 50-100 ml. For intramuscular injections, you need to add 2.5 ml of saline solution, water for injection or 1% Lidocaine per 1 g of Cefepime.

Possible complications and side effects

The main complications of the administration of Cefepime and Ceftriaxone are considered to be an allergic reaction and pseudomembranous colitis. Allergies can manifest themselves:

skin rash, redness, itching;
drug fever;
severe damage to the skin - the formation of blisters with detachment of the outer layer of skin;
hives;
difficulty breathing;
paroxysmal cough.

Allergic rash
Due to a disturbance in the intestinal microflora, dysbiosis occurs with intestinal inflammation - pseudomembranous colitis. It is accompanied by pain and bloating, diarrhea.

Less common adverse reactions include:

headache;
sleep disturbance;
convulsions;
addition of a fungal infection;
deterioration of the kidneys and liver;
changes in the blood - decrease in red blood cells, platelets, leukocytes;
chest pain, rapid pulse.

We recommend reading about how to dilute Ceftriaxone with Lidocaine. From the article you will learn how to dilute 2% Lidocaine to 1%, whether it is possible to inject without Lidocaine, how to dilute the antibiotic with water and Lidocaine. And here is more information on how to calculate the dosage of Ceftriaxone injections for children.

Cefepime or Ceftriaxone is prescribed for inflammation of the respiratory and urinary tract, infections in the abdominal cavity. The first drug is stronger, it is most often used for injection into a vein for severe inflammation.

conclusions

Rational therapy of pulmonary infections is a difficult problem today due to the difficulty of verifying microbiological diagnosis and the increasing frequency of resistant microflora. The combined drug Sulbactomax seems to be a reasonable, significantly more effective alternative to unprotected cephalosporins in the treatment of patients with CAP of groups II, III and IV, both adults and children. The inhibitor-protected ceftriaxone Sulbactomax expands the medical arsenal in the treatment of problem patients, in particular with severe community-acquired and nosocomial pneumonia caused by ESBL producers.

Prepared by Konstantin Kremets