Plutonium Pu Pub. Overview of the Statutory Accident Benefits Schedule SABS Ontario Regulation 3410 effective September 1, 2010. Prepared by Darcy Merkur Leonard Kunka of. Edition. MARK ROLLINS Washington University, USA Updated and revised new edition presents a series of essays by leading Danto scholars who offer their critical. FDA prescribing information, side effects and uses. Cefepime for injection, USP is a semi synthetic, broad spectrum, cephalosporin antibiotic for parenteral administration. The chemical name is 1 6. R,7. R 7 2 2 amino 4 thiazolyl glyoxylamido 2 carboxy 8 oxo 5 thia 1 azabicyclo4. Z O methyloxime, monohydrochloride, monohydrate, which corresponds to the following structural formula Cefepime hydrochloride is a white to pale yellow powder. Cefepime hydrochloride contains the equivalent of not less than 8. Cefepime C1. 9H2. N6. O5. S2 per mg, calculated on an anhydrous basis. Guides To The Evaluation Of Permanent Impairment 4Th Edition' title='Guides To The Evaluation Of Permanent Impairment 4Th Edition' />Twice the State average weekly earnings. Unallocated claims. What+is+Ligament+Laxity.jpg' alt='Guides To The Evaluation Of Permanent Impairment 4Th Edition' title='Guides To The Evaluation Of Permanent Impairment 4Th Edition' />It is highly soluble in water. Cefepime for injection, USP is supplied for intramuscular or intravenous administration in strengths equivalent to 1 g, and 2 g of Cefepime. See DOSAGE AND ADMINISTRATION. Cefepime for injection, USP is a sterile, dry mixture of Cefepime hydrochloride and L arginine. It contains the equivalent of not less than 9. Cefepime C1. 9H2. N6. O5. S2. The L arginine, at an approximate concentration of 7. Cefepime, is added to control the p. H of the constituted solution at 4 to 6. Freshly constituted solutions of Cefepime for injection, USP will range in color from pale yellow to amber. Cefepime Clinical Pharmacology. Cefepime is an antibacterial agent belonging to the cephalosporin class of antibacterials with in vitro antibacterial activity against facultative Gram positive and Gram negative bacteria. Pharmacokinetics. The average plasma concentrations of Cefepime observed in healthy adult male volunteers n9 at various times following single 3. IV of Cefepime 5. Table 1. Elimination of Cefepime is principally via renal excretion with an average SD half life of 2 0. Lmin in healthy volunteers. Cefepime pharmacokinetics are linear over the range 2. There is no evidence of accumulation in healthy adult male volunteers n7 receiving clinically relevant doses for a period of 9 days. Absorption. The average plasma concentrations of Cefepime and its derived pharmacokinetic parameters after intravenous IV administration are portrayed in Table 1. Table 1 Average Plasma Concentrations in mcgm. L of Cefepime and Derived Pharmacokinetic Parameters SD, Intravenous Administration. Parameter. Cefepime. IV1 g IV2 g IV0. 5 h. Cmax, mcgm. L3. 9. AUC, hmcgm. L7. Number of subjectsmale9. Following intramuscular IM administration, Cefepime is completely absorbed. The average plasma concentrations of Cefepime at various times following a single intramuscular injection are summarized in Table 2. The pharmacokinetics of Cefepime are linear over the range of 5. Table 2 Average Plasma Concentrations in mcgm. L of Cefepime and Derived Pharmacokinetic Parameters SD, Intramuscular Administration. Cefepime. Parameter. IM1 g IM2 g IM0. 5 h. Cmax, mcgm. L1. 3. Tmax, h. 1. 4 0. AUC, hmcgm. L6. Number of subjectsmale6. Distribution The average steady state volume of distribution of Cefepime is 1. L. The serum protein binding of Cefepime is approximately 2. Cefepime is excreted in human milk. A nursing infant consuming approximately 1. L of human milk per day would receive approximately 0. Cefepime per day. See PRECAUTIONS Nursing Mothers. Concentrations of Cefepime achieved in specific tissues and body fluids are listed in Table 3. Table 3 Average Concentrations of Cefepime in Specific Body Fluids mcgm. L or Tissues mcggTissue or Fluid. DoseRoute of Patients. Average Time of. Sample Post Dose hAverage. Concentration. Blister Fluid. IV6. 1. 5. 81. 4 mcgm. LBronchial Mucosa. IV2. 04. 8. 24. 1 mcgg. Sputum. 2 g IV5. 47. LUrine. 50. 0 mg IV8. L1 g IV1. 20 to 4. L2 g IV1. 20 to 4. LBile. 2 g IV2. 69. LPeritoneal Fluid. IV1. 94. 4. 18. 3 mcgm. LAppendix. 2 g IV3. Gallbladder. 2 g IV3. Prostate. 2 g IV5. Data suggest that Cefepime does cross the inflamed blood brain barrier. The clinical relevance of these data is uncertain at this time. Metabolism and Excretion Cefepime is metabolized to N methylpyrrolidine NMP which is rapidly converted to the N oxide NMP N oxide. Urinary recovery of unchanged Cefepime accounts for approximately 8. Less than 1 of the administered dose is recovered from urine as NMP, 6. NMP N oxide, and 2. Cefepime. Because renal excretion is a significant pathway of elimination, patients with renal dysfunction and patients undergoing hemodialysis require dosage adjustment. See DOSAGE AND ADMINISTRATION. Specific Populations. Renal impairment Cefepime pharmacokinetics have been investigated in patients with various degrees of renal impairment n3. The average half life in patients requiring hemodialysis was 1. Cefepime total body clearance decreased proportionally with creatinine clearance in patients with abnormal renal function, which serves as the basis for dosage adjustment recommendations in this group of patients. See DOSAGE AND ADMINISTRATION. Hepatic impairment The pharmacokinetics of Cefepime were unaltered in patients with hepatic impairment who received a single 1 g dose n1. Geriatric patients Cefepime pharmacokinetics have been investigated in elderly 6. SD creatinine clearance was 7. Lmin. There appeared to be a decrease in Cefepime total body clearance as a function of creatinine clearance. Therefore, dosage administration of Cefepime in the elderly should be adjusted as appropriate if the patients creatinine clearance is 6. Lmin or less. See DOSAGE AND ADMINISTRATION. Pediatric patients Cefepime pharmacokinetics have been evaluated in pediatric patients from 2 months to 1. Following a single intravenous dose, total body clearance and the steady state volume of distribution averaged 3. Lminkg and 0. 3 0. Lkg, respectively. The urinary recovery of unchanged Cefepime was 6. Lminkg. There were no significant effects of age or gender 2. No accumulation was seen when Cefepime was given at 5. Cmax, AUC, and t were increased about 1. The exposure to Cefepime following a 5. The absolute bioavailability of Cefepime after an intramuscular dose of 5. Microbiology. Mechanism of Action. Cefepime is a bactericidal agent that acts by inhibition of bacterial cell wall synthesis. Toni Auto 3. Cefepime has a broad spectrum of in vitro activity that encompasses a wide range of Gram positive and Gram negative bacteria. Cefepime has a low affinity for chromosomally encoded beta lactamases. Cefepime is highly resistant to hydrolysis by most beta lactamases and exhibits rapid penetration into Gram negative bacterial cells. Within bacterial cells, the molecular targets of Cefepime are the penicillin binding proteins PBP. Cefepime has been shown to be active against most isolates of the following microorganisms, both in vitro and in clinical infections as described in the INDICATIONS AND USAGE section. Gram negative bacteria. Enterobacter spp. Escherichia coli Klebsiella pneumoniae. Proteus mirabilis. Pseudomonas aeruginosa Gram positive bacteria. Staphylococcus aureus methicillin susceptible isolates onlyStreptococcus pneumoniae. Streptococcus pyogenes. Viridans group streptococci. The following in vitro data are available, but their clinical significance is unknown. At least 9. 0 percent of the following bacteria exhibit an in vitro minimum inhibitory concentration MIC less than or equal to the susceptible breakpoint for Cefepime. However, the efficacy of Cefepime in treating clinical infections due to these bacteria has not been established in adequate and well controlled clinical trials. Gram positive bacteria.