J Antimicrob Chemother  2003 Mar;51(3):651-8 

Stability and compatibility study of cefepime in comparison with ceftazidime for
potential administration by continuous infusion under conditions pertinent to
ambulatory treatment of cystic fibrosis patients and to administration in
intensive care units.

Baririan N, Chanteux H, Viaene E, Servais H, Tulkens PM.

Unite de Pharmacologie Cellulaire et Moleculaire, Universite Catholique de
Louvain, UCL 73.70 avenue E. Mounier 73, B-1200 Brussels, Belgium.

Cefepime has been examined for stability, potential liberation of degradation
products and compatibility with other drugs under conditions mimicking its
potential use by continuous infusion in cystic fibrosis and intensive care
patients (5-12% w/v solutions; temperatures from 20 to 37 degrees C; 1 h contact
at 25 degrees C with other drugs frequently co-administered by intravenous route
to these types of patients). Ceftazidime was used as a comparator based on a
previous normative study with this antibiotic for the same indications. Based on
a limit of max. 10% degradation, cefepime can be considered stable for a maximum
of 24 h at 25 degrees C, but for only approximately 14 h at 30 degrees C, and
for <10 h at 37 degrees C. Cefepime released so far unidentified degradation
products if maintained at >30 degrees C for >12 h as shown from a marked
increase in pH and from the development of a strong red-purple colour.
Incompatibilities were observed with erythromycin, propofol, midazolam,
phenytoin, piritramide, theophylline, nicardipine, N-acetylcysteine and a
concentrated solution of dobutamine. We conclude that: (i) cefepime cannot be
used safely by continuous infusion if containers are kept for more than a few
hours at 37 degrees C (as will be the case for cystic fibrosis patients if using
portable pumps carried under clothes); (ii) caution must be exercised in
intensive care patients if the temperature and co-administration of other drugs
is not kept under tight control. The nature and safety of the cefepime
degradation products need to be studied further.

PMID: 12615867 [PubMed - in process]