A non-comparative, multicentre study of cefepime in the treatment of serious bacterial infections

Abstract

Multi-resistant strains of Gram-negative bacteria are rapidly emerging as a frequent cause of serious bacterial infection in the hospital environment. Effective treatment must include an antibiotic with activity against these organisms. In an open multicentre study, cefepime was evaluated as empirical therapy in 156 hospitalized patients (mean age 57 years) with serious infection of the urinary tract (n = 43), lower respiratory tract (n = 101) and skin and soft tissue (n = 12). In 18 patients, septicaemia/bacteraemia was also diagnosed. Cefepime, 2 g bd, was administered for a maximum of 16 days (mean 8). Of 98 pathogens isolated, 75 were Gram-negative and 23 were Gram-positive species. Ninety-four of the pathogens were susceptible to cefepime, including multi-resistant isolates such as Pseudomonas aeruginosa and Enterobacter cloacae. The overall clinical cure rate, excluding septicaemia/bacteraemia, was 92% (94/102); the corresponding bacterial eradication rate was 95% (52/55). In patients with septicaemia/bacteraemia, the clinical cure rate was 87% (13/15) despite eradication of 100% (11/11) of the assessable pathogens. Cefepime was well-tolerated, although 14 (9%) patients experienced local intolerance at the infusion site. Other drug-related adverse events were reported in six (4%) patients and included diarrhoea, pruritus, rash and urticaria. Cefepime is safe and effective as empirical treatment for serious infections commonly found in the hospital setting. Clinical cure and bacterial eradication can be achieved with a convenient bd dosing schedule.

Cefepime versus ceftazidime: considerations for empirical use in critically ill patients

“…Both compounds are structurally similar except for a methyl-pyrrolidino group that gives the cefepime molecule a zwitterionic configuration [17]. This offers cefepime an apparent chemical advantage of enhanced bactericidal activity by rapid penetration of the porin channels in the outer membrane of Gram-negative bacteria [18,19].…”

“…Cefepime is active against Enterobacter spp., especially ceftazidime-resistant Enterobacter aerogenes [18], and has broadened antipseudomonal activity. Kieft et al [27] compared cefepime with ceftazidime as initial therapy for patients with sepsis syndrome due to serious bacterial infections in 114 patients.…”

Fourth-generation cephalosporins: a review of in vitro activity, pharmacokinetics, pharmacodynamics and clinical utility

“…The fourth‐generation cephalosporins, with their broad antibacterial spectrum, would be an attractive therapeutic alternative, administered empirically, either as monotherapy or as part of a combination regimen. Initial studies utilizing fourth‐generation cephalosporins in patients suffering from severe nosocomial pneumonia in the ICU are encouraging 52,53. Cefpirome is one of the most potent β‐lactam antibiotics against penicillin‐resistant pneumococci and staphylococci 15,26,27,74 and should be useful for the treatment of hospitalized patients with severe, community‐acquired pneumonia or early‐onset nosocomial pneumonia.…”

“…Cefepime 2 g bid has also been shown to be effective in the treatment of severe community‐acquired or nosocomial pneumonia 52,53. In a comparative study, a satisfactory response was reported in 75% of the cefepime patients and 74% of patients receiving ceftazidime or cefotaxime 2 g tid 53.…”

Ventilator-associated pneumonia—Understanding epidemiology and pathogenesis to guide prevention and empiric therapy

“…A larger and more recent multicenter study compared the efficacy and safety of cefpirome and ceftazidime, either as monotherapy or in combination, with an aminoglycoside or metronidazole in the empiric treatment of 400 patients with nosocomial and community‐acquired pneumonia in the ICU 94, Clinical failure rates at the end of treatment were 34% vs 36% for cefpirome bid and ceftazidime tid, respectively, with no difference in outcome between monotherapy and combination therapy. In a non‐comparative study, a satisfactory clinical response was obtained in 89% of patients receiving cefepime bid 95. Based on these studies, it can be assumed that fourth‐generation cephalosporins are good alternatives to other broad‐spectrum antibiotics for the treatment of nosocomial pneumonia.…”