Cefepime (Maxipime) is one of the big gun beta-lactams we reach for in serious infections such as health care associated pneumonia and fever with neutropenia. Two recent papers suggest we need to rethink our choice of big guns.
A meta-analysis of trials comparing anti-pseudomonal beta-lactam antibiotics for treatment of febrile neutropenia concluded that cefapime was associated with increased mortality compared with other beta-lactams.
More recently a meta-analysis was done comparing cefipime with other beta-lactams for a variety of indications, again finding an increased mortality with cefipime. The increase in mortality could not be attributed to treatment failure, superinfection or specific adverse events. The authors speculated that discrepancies between in vitro and in vivo results or unidentified adverse effects may have explained the increase in mortality. Possible adverse effects include encephalopathy and non-convulsive status epilepticus, which have been noted in post marketing reports.