Cefepime versus cefotaxime in the treatment of lower respiratory tract infections

Abstract

Patients with lower respiratory tract infection (LRTI) were randomized 2:1 to receive either cefepime 2 g i.v. bd or cefotaxime 2 g i.v. tds. Bronchopneumonia alone or associated with another LRTI was diagnosed in 30 of 37 cefepime recipients and in 11 of 18 cefotaxime recipients; other diagnoses included bronchitis, lobar pneumonia and aspiration pneumonia. The mean duration of treatment was 5.9 days in the cefepime group and 5.4 days in the cefotaxime group. There were no significant differences between the two groups with regard to clinical or bacteriological outcome. Treatment was associated with a satisfactory clinical response in 27 (73%) of 37 evaluable cefepime patients and in 10 (56%) of 18 evaluable cefotaxime patients. Treatment resulted in eradication of 33 (89%) of 37 pathogens in the cefepime group, including 13 of 15 strains of Staphylococcus aureus, and of 16 (73%) of 22 pathogens in the cefotaxime group, including eight of ten strains of S. aureus. Two Pseudomonas aeruginosa strains persisted in the cefotaxime group. The sole clinical adverse event reported was a rash in one cefepime patient which did not require discontinuation of treatment. No clinically relevant changes in laboratory test results were attributed to either agent. Cefepime twice daily and cefotaxime three times daily were of comparable safety and efficacy in the treatment of bronchopneumonia and other LRTIs.

Antimicrobial therapy for patients with severe sepsis and septic shock: An evidence-based review

“…Response rates for the various cephalosporins were in the range of 65% to 85% in most studies, except for slightly lower response rates for ceftriaxone and cefotaxime in two smaller studies (101,104).…”

“…In summary, as one might have anticipated given the fairly comparable antimicrobial spectrum of activity of most third-generation and fourth-generation cephalosporins, the studies conducted with these agents for the treatment of patients with severe sepsis and community-acquired or nosocomial (including ventilator-associated) pneumonia or miscellaneous types of infections have yielded very comparable results (Table 2) (91,93,94,98,(101)(102)(103)(104)108). Response rates for the various cephalosporins were in the range of 65% to 85% in most studies, except for slightly lower response rates for ceftriaxone and cefotaxime in two smaller studies (101,104).…”

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 Imipenem-Cilastatin for Treatment of Nosocomial Pneumonia in Intensive Care Unit Patients: a Multicenter, Evaluator-Blind, Prospective, Randomized Study

“…Cefepime is therefore an appealing option for monotherapy of nosocomial pneumonia. Several trials with relatively small sample sizes comparing cefepime with ceftazidime or cefotaxime suggested that cefepime is as effective as broad-spectrum cephalosporins for the treatment of community-acquired lower respiratory tract infections (2,10,19).…”