Forgen IV/IM 500 mg Injection: Each vial contains sterile dry mixture of Cefepime Hydrochloride USP equivalent to Cefepime 500 mg premixed with L-Arginine. Forgen IV/IM 1 g Injection: Each vial contains sterile dry mixture of Cefepime Hydrochloride USP equivalent to Cefepime 1 g premixed with L-Arginine. Forgen IV 2 g Injection: Each vial contains sterile dry mixture of Cefepime Hydrochloride USP equivalent to Cefepime 2 g premixed with L-Arginine.

Cefepime is indicated for the treatment of the following infections caused by susceptible bacteria- • Lower respiratory tract infections, including pneumonia and bronchitis • Urinary tract infections, both complicated, including pyelonephritis, and uncomplicated infections • Skin and skin structure infections • Septicaemia • Intra-abdominal infections, including peritonitis and biliary tract infections • Empiric treatment of febrile neutropenia • Surgical prophylaxis • Meningitis

\n \nCefepime can be administered either intravenously or intramuscularly. The dosage and route vary according to the susceptibility of the causative organisms, the severity of the infection, renal function and the overall condition of the patient. Adults: Guidelines for dosage of adults and aged above 12 with normal renal function- \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n

Infection	Dose	Frequency
Severe infections including pneumonia, urinary tract infections, complicated intra-abdominal infections, including cases with an associated bacteremia	2g IV	12 hourly
Mild to moderate urinary tract infections (uncomplicated and complicated)	500mg – 1g IV or IM
Mild to moderate infections including bronchitis, skin and skin-structure infections	1g IV or IM
Empiric treatment of febrile neutropenia	2g IV	8 hourly
Surgical prophylaxis	2g IV	Single dose

\n* Usual duration of therapy is 7-10 days; more severe infections may require longer treatment. In the treatment of beta-haemolytic streptococcal infections a therapeutic dose must be administered for at least 10 days. For empirical treatment of febrile neutropenia, usual duration of therapy is 7 days or until resolution of neutropenia.Paediatrics?Usual recommended dosages of children aged 1 month to 12 years with normal renal function- \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n

Infection	Dose & frequency
Pneumonia, urinary tract infections, and skin structure infections	Patients 2 months of age with body weight > 40 kg: 50 mg/kg 12 hourly for 10 days. For more severe infections, a dosage schedule of 8 hourly can be used.
Empiric treatment of febrile neutropenia	Patients >2 months of age with body weight >40 kg: 50 mg/kg 8 hourly for 7-10 days.
Experience with the use of Cefepime in paediatric patients >2 months of age is limited. A dosage of 30 mg/kg 12 hourly or 8 hourly may be considered for patients aged 1 month to 2 months.
For paediatric patients with body weight > 40 kg, adult dosing is recommended. For patients older than 12 years who are >40 kg, the dosage recommendations for younger patients >40 kg should be used. Dosage in paediatric patients should not exceed the maximum recommended dosage in adults (2 g 8 hourly). Experience with intramuscular administration in paediatric patients is limited.

\nImpaired hepatic function?No dosage adjustment is necessary for patients with impaired hepatic function.?Impaired renal function?The initial dose of Cefepime is the same as in patients with normal renal function. The recommended maintenance doses of cefepime in patients with renal insufficiency are - \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n

Creatinine clearance	Recommended Maintenance Dosage
(ml/min)
> 60, Usual dose, no adjustment necessary	500mg 12 hourly	1g 12 hourly	2g 12 hourly	2g 8 hourly
30-60	500mg 24 hourly	1g 24 hourly	2g 24 hourly	1g 8 hourly
11-19	500mg 24 hourly	500mg 24 hourly	1g 24 hourly	1g 12 hourly
>11	250mg 24 hourly	250mg 24 hourly	500mg 24 hourly	1g 12 hourly

\nPreparation of solution and administration?Cefepime powder is to be reconstituted using the volumes of diluent shown in table- \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n

Single dose vial	Amount of diluent to be added (ml)
500mg IV	5
1g IV	10
2g IV	10
500mg IM	1.5
1g IM	3.0

\nCefepime is compatible at concentrations between 1 and 40 mg/ml with one of the following IV infusion fluids: (a) 0.9% Sodium Chloride Injection (b) 5% and 10% Dextrose Injection, These solutions are stable for 24 hours at room temperature or 7 days under refrigeration (2°C to 8°C). \n \n

Cefepime is contraindicated in patients who have had previous hypersensitivity reactions to any component of the formulation, the cephalosporin class of antibiotics, penicillins or other beta-lactam antibiotics.

Renal function should be monitored carefully if drugs with nephrotoxic potential, such as aminoglycosides and potent diuretics, are administered with Cefepime. Pseudomembranous colitis has been reported with virtually all broad-spectrum antibiotics including Cefepime. Use of Cefepime may result in overgrowth of nonsusceptible organisms. If superinfection occur during therapy, appropriate measures should be taken.

Cefepime is generally well tolerated. But the most common adverse events are- • Hypersensitivity - rash, pruritus, urticaria. • Gastrointestinal - nausea, vomiting, oral moniliasis, diarrhea, colitis (including pseudomembranous colitis) • Central nervous system - headache • Other - fever, vaginitis, erythema etc.

Renal function should be carefully monitored if high doses of aminoglycosides are to be administered with cefepime or if aminoglycoside therapy is prolonged, because of the potential nephrotoxicity and ototoxicity of aminoglycoside antibiotics.

Use in pregnancy: Pregnancy category B. There are no adequate and well-controlled studies in pregnant women. So, this drug should be used during pregnancy only if clearly needed. Use in lactation: Cefepime is excreted in human breast milk in very low concentrations. Caution should be exercised when cefepime is administered to a nursing woman.

Forgen IV/IM 500 mg Injection: Combipack of 1 vial of Cefepime 500 mg (As Cefepime Hydrochloride USP) sterile powder and 1 ampoule of 5 ml Water for injection BP. Forgen IV/IM 1 g Injection: Combipack of 1 vial of Cefepime 1 g (As Cefepime Hydrochloride USP) sterile powder and 1 ampoule of 10 ml Water for injection BP. Forgen IV 2 g Injection: Combipack of 1 vial of Cefepime 2 g (As Cefepime Hydrochloride USP) sterile powder and 1 ampoule of 10 ml Water for injection BP.