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Efficacy and safety of cefepime in late-onset ventilator-associated pneumonia in infants: a pilot randomized and
1Department of Pediatrics, Duchess of Kent Hospital, Sandakan 90000, Sabah, Malaysia. sukhbir5@lycos.com
Insights
Cefepime demonstrated effectiveness in treating infant late-onset ventilator-associated pneumonia (VAP), showing improved clinical response and microbiological clearance compared to ceftazidime. This pilot study suggests cefepime is a safe and viable option for VAP in infants.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Pharmacology
Background:
- Late-onset ventilator-associated pneumonia (VAP) is frequently caused by multidrug-resistant organisms in infants.
- Effective antibiotic strategies are crucial for managing VAP in critically ill neonates and infants.
Purpose of the Study:
- To evaluate the efficacy and safety of cefepime compared to ceftazidime for treating late-onset VAP in infants.
- To assess clinical response, microbiological clearance, and adverse events associated with cefepime and ceftazidime therapy.
Main Methods:
- A pilot, randomized, controlled study was conducted in Malaysia involving 30 infants (<1 year) with late-onset VAP.
- Participants were randomized to receive either cefepime or ceftazidime.
- Clinical responses, tracheal aspirate microbiological clearance, and adverse events were monitored.
Main Results:
- A higher proportion of infants receiving cefepime showed a satisfactory clinical response (10/15) compared to ceftazidime (5/15) (P<0.1).
- Cefepime demonstrated superior microbiological clearance of polymicrobial infections from tracheal aspirates.
- No fatalities occurred in the cefepime group, versus three in the ceftazidime group (P<0.1); no serious adverse effects were noted.
Conclusions:
- Cefepime monotherapy appears to be as effective and safe as ceftazidime monotherapy for late-onset VAP in infants.
- Cefepime offers improved microbiological clearance, making it a promising treatment option for VAP in this population.
Abstract:
Multidrug-resistant organisms cause late-onset ventilator-associated pneumonia (VAP). In a pilot, randomized and controlled study, the efficacy and safety of cefepime, in late-onset VAP in infants, have now been evaluated in Malaysia. Thirty children aged <1 year with late-onset VAP (i.e. VAP occurring 5 or more days after intubation) were randomized to receive cefepime or, as a control, ceftazidime. The clinical responses and the microbiological clearance of tracheal aspirates were evaluated in each arm. Adverse events, if any, were monitored clinically and by blood tests. Ten of the 15 children given cefepime and five of the 15 given ceftazidime showed a satisfactory clinical response (P<0.1). Cefepime appeared significantly better at clearing polymicrobial infections from tracheal aspirates. There were no fatalities in the cefepime arm but three in ceftazidime (P<0.1). The mean (S.E.) durations of antibiotic use were 9.4 (1.5) days for cefepime and 7.6 (1.0) days for ceftazidime (P>0.05). No serious adverse effects were observed in either arm. In conclusion, in late-onset VAP in infants, cefepime monotherapy appears to be at least as effective and safe as ceftazidime monotherapy, with better microbiological clearance.
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