Treatment of community-acquired pneumonia in the elderly: the role of cefepime, a fourth-generation cephalosporin

Abstract

In a prospective, multicentre double-blind trial, 151 patients over the age of 65 years were randomly assigned to receive either cefepime 2 g every 12 h for a minimum of 3 days and up to 14 days or ceftriaxone 1 g every 12 h for a minimum of 3 days and up to 14 days. Antibiotics were maintained until 48 h after fever had resolved; no other antibiotics were permitted. The average age in each group exceeded 77 years and significant co-morbidity was found in the majority of patients. The mean total duration of therapy was 5.8+/-2.4 days for the cefepime group and 6.7+/-2.7 days for the ceftriaxone group (P = 0.06). The clinical success rate at the end of therapy was 79.1% with cefepime and 75.4% with ceftriaxone (P = 0.62). At the end of follow-up, 91.7% of the cefepime-treated patients and 86.5% of the ceftriaxone patients had a satisfactory clinical response (P = 0.38). In 35 bacteriological evaluable patients, potential pathogens were eradicated in all but one patient receiving cefepime. Seven patients in each group died during the study period but in each case the death was unrelated to study drug. The commonest side-effect was diarrhoea (cefepime, five patients; ceftriaxone, two patients). The clinical and microbiological efficacy of cefepime is similar to that of ceftriaxone in elderly patients with community-acquired pneumonia requiring hospitalization. Cefepime is an appropriate choice for the treatment of community-acquired respiratory tract infections in the elderly.

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).…”

The safety of cefepime in the treatment of infection

“…Deaths within 30 days of completing treatment occurred in 5% of patients treated with either cefepime or ceftazidime, but mortality was not considered related to the studied drugs [98] . By contrast, comparison of cefepime with ceftriaxone given intramuscularly once daily for treatment of nursing home-acquired pneumonia evidenced a lower mortality in the cefepime group than in the comparator one (6.2 versus 10.3%, cefepime versus ceftriaxone) [56] .…”

“…Several trials comparing cefepime with ceftazidime, ceftriaxone, cefotaxime or other β -lactams alone or in combination with other agents have shown similar efficacies in both communityand hospital-acquired pneumonia, although caution should be used for ESBL bacteria [54][55][56][57][58][59][60][61] . Cephalosporins generally eradicated the causative organisms of community-acquired pneumonia including Haemophilus spp., Moraxella catarrhalis and Enterobacter spp., while bacteriological failures were observed in some trials with P. aeruginosa and S. pneumoniae [1,54,55] .…”