Level 2: Mid-level evidence

Mortality associated with cefepime (Maxipime) was evaluated in a systematic review and meta-analysis of 57 randomized trials comparing cefepime with another beta-lactam antibiotic; the review was limited by lack of complete mortality data from all of the trials (Lancet Infect Dis. 2007;7:338-348). An additional non-beta-lactam antibiotic was allowed if the same drug and dose was used in both study groups.

Comparing cefepime vs. other drugs, overall rate of all-cause mortality was 7.86% vs. 6.36% in a meta-analysis of 41 trials with 7,388 patients (P=.005). In subgroup analyses of individual drugs, cefepime was associated with increased mortality vs. piperacillin-tazobactam and nonsignificant trends toward increased mortality with other drugs (ceftazidime, imipenem or meropenem, ceftriaxone or cefotaxime). Mortality was higher in patients with neutropenic fever in a meta-analysis of 19 trials with 3,971 patients (6.36% vs. 4.51%); there were no differences in meta-analysis of patients with pneumonia in 10 trials with 1,720 patients. The differences in mortality were larger in trials with higher methodologic quality.

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The rates of clinical failure were lower with cefepime in a meta-analysis of 15 trials of 1,487 patients with community-acquired pneumonia (12.9% vs. 16%, P=.05); no significant differences were seen in patients with febrile neutropenia (20 trials with 4,410 patients) or hospital-acquired pneumonia (three trials). There were no significant differences between groups in rates of superinfection or adverse events.