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.
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.