Low-dosage cefepime as treatment for serious bacterial infections.

Abstract

Since infection develops in significant numbers of hospitalized patients, the problem of resistance to third-generation cephalosporins is of increasing concern. We evaluated the efficacy of cefepime 1 g bd as treatment for acute, moderately severe bacterial infection in 239 hospitalized patients (mean age 60 years). Of these patients, 204 were evaluated clinically for urinary tract infection (UTI) (n = 90), lower respiratory tract infection (LRTI) (n = 70), skin and soft tissue infection (S/STI) (n = 12) and bacteraemia which was associated with either UTI or LRTI (n = 32) but not included in the previously mentioned UTI and LRTI groups. Amongst the pathogens isolated (36 Gram-positive, 150 Gram-negative), the most predominant species were Escherichia coli in UTI and bacteraemia (n = 81), Streptococcus pneumoniae in LRTI and bacteraemia (n = 23), Haemophilus influenzae in LRTI (n = 16), Pseudomonas aeruginosa (n = 4) and Enterobacter cloacae (n = 2) in S/STI. The mean duration of treatment was 8.5 days and was the same for the 204 clinically evaluable patients. Overall, the clinical cure rate for cefepime was 94% (191/204). Pathogen eradication was achieved in 93% (185/199) of infections. Of the patients with associated bacteraemia, the clinical cure rate was 97% (31/32) and 94% (16/17) of the pathogens were eradicated. Cefepime therapy was well-tolerated. Treatment was discontinued in eight patients (3%) because of local intolerance and in five patients (2%) because of drug-related adverse events (rash, headache and pruritus). Cefepime 1 g bd is as safe and effective as other parenteral cephalosporins for the treatment of acute bacterial UTI, LRTI and S/STI, including those cases with associated bacteraemia. The bd dosing schedule and reported lack of cross-resistance with other cephalosporins against some species of aerobic Gram-negative bacilli make cefepime an attractive treatment option in hospitalized patients.

• Authors: H Giamarellou
• Journal: The Journal of antimicrobial chemotherapy (J Antimicrob Chemother) Vol. 32 Suppl B Pg. 123-32 (Nov 1993) ISSN: 0305-7453 [Print] England
• PMID: 8150755 (Publication Type: Clinical Trial, Journal Article, Multicenter Study)

Chemical References

• Cephalosporins
• Powders
• Cefepime

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Bacteremia (drug therapy, microbiology)
• Bacteria (drug effects)
• Bacterial Infections (drug therapy, microbiology)
• Cefepime
• Cephalosporins (administration & dosage, adverse effects, therapeutic use)
• Female
• Freeze Drying
• Humans
• Male
• Microbial Sensitivity Tests
• Middle Aged
• Powders
• Respiratory Tract Infections (drug therapy, microbiology)
• Skin Diseases, Infectious (drug therapy, microbiology)
• Therapeutic Equivalency
• Urinary Tract Infections (drug therapy, microbiology)