Cefepime compared with ceftazidime as initial therapy for serious bacterial infections and sepsis syndrome

Abstract

In an open randomized multicenter comparative study, we evaluated the safety and efficacy of cefepime (CP; 2.0 g given intravenously every 12 h) and ceftazidime (CZ; 2.0 g given intravenously every 8 h) as initial treatment for adult patients with suspected serious bacterial infections. A total of 133 patients entered the study, of whom 114 were evaluable for clinical and microbiological response assessment: 56 received CP and 58 received CZ. About 50%o (30 who received CP and 25 who received CZ) fulfilled the criteria of the sepsis syndrome. The treatment groups were comparable with respect to sex distribution, mean age, underlying diseases, treatment duration, APACHE II score, and type of infection. The most commonly cultured microorganisms were members of the family Enterobacteriaceae, Streptococcus pneumoniae, and Staphylococcus aureus. The causative microorganisms were eradicated from 92% (37 of 40) of patients with a microbiologically documented infection who underwent treatment with CP; they were eradicated from 86% (42 of 49) of patients who received CZ. The responses of only clinically documented infections in the CP group were 90% (27 of 30 patients); in the CZ group they were 87% (26 of 30 patients). When patients fulfilled the criteria of the sepsis syndrome (septic shock excluded), the causative microorganisms were eradicated from 89%o (16 of 18) of CP-treated patients and 86% (12 of 14) of CZ-treated patients. None of these differences was statistically significant. Mortality was the same in both groups (four patients in each group) and was not attributable to the study medication. In conclusion, CP is at least as effective and as safe as CZ as initial antimicrobial therapy for suspected serious bacterial infections in nonneutropenic patients with or without the sepsis syndrome. CP has the additional advantage in that it can be given twice daily, which may lead to a decrease in hospital costs.

Antibiotic therapy for inducible AmpC β-lactamase-producing Gram-negative bacilli: what are the alternatives to carbapenems, quinolones and aminoglycosides?

“…Cefepime appeared to have clinically equivalent efficacy and safety to comparator antibiotics in a variety of infections such as pneumonia [56], sepsis [57], Gram-negative bacteraemia [58], peritonitis (when combined with metronidazole) [59,60] and lower respiratory tract infections both in adults and children [61,62]. Several randomised trials suggested equivalence between cefepime and comparator antibiotics as monotherapy for neutropenic sepsis, including paediatric patients [63][64][65].…”

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

“…Kieft et al [27] compared cefepime with ceftazidime as initial therapy for patients with sepsis syndrome due to serious bacterial infections in 114 patients. The authors observed a trend towards superior efficacy of cefepime, although this difference did not achieve statistical significance.…”

Cefepime: a reappraisal in an era of increasing antimicrobial resistance

“…Colitis (including pseudomembranous colitis), diarrhea, fever, headache, nausea, oral moniliasis, pruritus, urticaria, vaginitis and vomiting were observed in less than 1% of patients. At the higher dose of 2 g every 6-8 h, the incidence of probably related adverse events was higher: rash (4%), diarrhea (3%), nausea (2%), vomiting (1%), pruritus (1%), fever (1%) and headache (1%) [47,60,92,93,113-115]. …”