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Cefepime was associated with a higher risk of death when compared with other β-lactam antibiotics, according to a recent review. SDI Productions/Getty
  • A recent review found that cefepime, a cephalosporin antibiotic, was associated with increased mortality compared with other β-lactam antibiotics.
  • The review authors observed that the increased risk of death was seen in adults taking cefepime. However, it did not appear to increase the risk in children.
  • Experts note that cefepime remains a viable choice for broad antibacterial treatment in life-threatening illnesses, but the potential mortality signal should be considered when framing its role in clinical practice.

Cefepime was associated with a higher risk of death than other β-lactam antibiotics, according to a recent review.

Cefepime is a cephalosporin antibiotic for the treatment of conditions such as:

  • pneumonia
  • urinary tract infections (UTIs)
  • bacterial meningitis

Now, the review published in September in JAMA Network Open found that the widely used antibiotic may be associated with more deaths than other, similar medications.

An increased risk was noted in adults taking cefepime, though the antibiotic did not appear to increase the risk of mortality in children.

The researchers note the importance of raising awareness of the possible risks of cefepime when considering its use in clinical practice.

The review authors found that 778 of the 11,726 people who received cefepime — or 6.6% — died.

This compares with 6.2% in those receiving a different type of β-lactam antibiotic.

This means that there was a difference of 4 deaths per 1,000 people, when comparing cefepime with other β-lactams.

David Michalik, DO, pediatric infectious disease specialist at Miller Children’s and Women’s Hospital, Long Beach, CA, spoke with Medical News Today.

“[Cefepime] remains a viable choice when a patient needs broad antibacterial treatment for what is often a life-threatening illness. This study is broad in its scope, including many different international studies with patients of all ages and suffering from different illnesses,” said Michalik, who was not involved in the review.

“While [the review authors] note a higher risk of death with all studies included across all ages and medical conditions, the broad scope makes it difficult to state cefepime use is more likely to lead to death compared [with] other beta-lactam antibiotics.”

The researchers found differences between age groups taking cefepime.

In the analysis, adults taking cefepime had an 18% higher risk of mortality.

However, among children taking cefepime, there was no evidence to suggest that cefepime was more or less harmful than other β-lactam antibiotics.”

“The authors do not state any specific reason to explain a mortality difference between cefepime use in adults and children,” Michalik said.

“Given the number of confounders in the included trials, along with the complexity of conditions as well as challenges with pharmacokinetics in children, it is difficult to assume there is some protective variable that children have and adults do not.”

The researchers observed a potential association between cefepime use and the risk of mortality among certain conditions.

The review noted that the chance of an increased risk of death with cefepime was around:

  • 19% in cases of febrile neutropenia
  • 19% in cases of severe bacterial infections
  • 11% in cases of pneumonia
  • 10% in cases of meningitis
  • 33% in cases of urinary tract infection

However, Michalik described these particular categories as “challenging to interpret and compare.”

He explained that “‘fever neutropenia’ refers to a patient with fever who has low neutrophils and is therefore susceptible to many pathogens, and ‘severe bacterial infection’ is a subjective label given to patients by their physicians for any number of reasons.”

He added, “The other categories of pneumonia, meningitis, and urinary tract infection could all potentially be labeled as a severe bacterial infection. Therefore, the percent difference of harm as well as odds ratio are challenging to infer concrete differences.”

The review authors advise that “the potential mortality signal associated with cefepime should be considered when framing its role in clinical practice guidance.”

Michalik said that “[t]his systematic review does lend caution to the start of cefepime for hospitalized patients. It is fair to make this conclusion, not exclusively because of the results of this study, but also because this antibiotic remains one of the few remaining broad antibacterials clinicians have available for treating complex and serious infections.”

He added, “All antibiotics should be used with caution, and both clinicians and patients should be clear in what antibiotic is being used and for what indication. Humanity is living in an era where multi-drug-resistant pathogens are widespread, something that affects every living thing on this planet.”

Michalik concluded, :”Antibacterials have their place, but they should only be prescribed when necessary. So much is at stake.”