Broad-spectrum cephalosporins with antipseudomonal activity: ceftazidime and cefepime

Ceftazidime and cefepime have an extended spectrum of activity, which includes activity against the majority of Enterobacterales (enteric gram-negative bacilli) and Pseudomonas aeruginosa. Ceftazidime is also active against Burkholderia pseudomallei.

Both drugs are inactivated by extended-spectrum beta-lactamase enzymes (ESBLs), and ceftazidime may be inactivated by cephalosporinase enzymes (see Broad-spectrum cephalosporins: cefotaxime and ceftriaxone for examples of bacteria that produce these enzymes). Ceftazidime has limited activity against gram-positive bacteria.

For patients with septic shock or requiring intensive care support, there is a theoretical benefit from administering the intermittent dose of ceftazidime over 3 to 4 hours, or administering the daily dose over 24-hours. However, at the time of writing, randomised controlled trials to evaluate the benefit of this approach are ongoing and there are inadequate data to recommend this approach.