Randomized Comparison of Cefepime and Ceftazidime for Treatment of Hospitalized Patients with Gram-Negative Bacteremia

Abstract

We conducted a randomized, prospective, open comparison to evaluate the efficacy and safety of cefepime and ceftazidime in the treatment of hospitalized patients with suspected gram-negative bacteremia. Twenty-eight patients with signs and symptoms of sepsis were prospectively randomized to receive cefepime (13 patients) or ceftazidime (15 patients). Cultures of blood obtained at entry into the study were positive for 24 (85.7%) of 28 patients. Eight patients had two or more positive pretreatment blood cultures, and the remaining 16 had one positive pretreatment blood culture. The most commonly isolated blood pathogen was Escherichia coli. Eleven of 13 patients treated with cefepime and 12 of 15 patients treated with ceftazidime were clinically cured. Adverse effects attributable to therapy with the study drugs were minimal in both groups of patients and included rash, headache, nausea, and diarrhea. Our results suggest that cefepime is an efficacious and well tolerated as is ceftazidime in the treatment of hospitalized patients with documented gram-negative bacteremia.

A multicenter comparative study of cefepime versus broad-spectrum antibacterial therapy in moderate and severe bacterial infections

“…Cefepime eradicated 97% of all pathogens, similar to comparator therapy (94%). Accordingly, this study extends the findings of previously published clinical studies, which found cefepime to be effective for the treatment of moderate to serious infections of the lower respiratory tract [19][20][21][22][23] and the urinary tract [24], as well as intraabdominal infections [25] and bacteremia [26].…”

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

“…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].…”