Comparison of the influence on renal function between cefepime and cefpirome

Area of Science:

• Pharmacology
• Nephrology
• Clinical Medicine

Background:

• Fourth-generation cephalosporins, including cefpirome and cefepime, are widely used for drug-resistant infections.
• Despite their efficacy, clinical observations suggest potential nephrotoxicity, necessitating further investigation.

Purpose of the Study:

• To elucidate the precise effects of cefpirome and cefepime on renal function.
• To compare the in vitro and in vivo nephrotoxic potentials of these two antibiotics.

Main Methods:

• In vitro: Renal cell viability assays were performed using varying concentrations of cefpirome and cefepime.
• In vivo: A clinical cohort study monitored serum creatinine (SCr) levels in patients treated with either cefpirome or cefepime.

Main Results:

• Cefpirome exhibited a higher inhibitory concentration (IC50) against renal mesangial cells compared to cefepime (143.5 µmol/l vs. 7.702 µmol/l).
• Clinical data showed cefpirome caused a more significant increase in average SCr levels and a higher incidence of renal failure (SCr >445 µmol/l) on days 3 and 7.
• Elderly patients (>65 years) were more susceptible to SCr elevation and renal failure with both antibiotics.

Conclusions:

• Cefpirome demonstrates a greater potential for inducing renal impairment than cefepime.
• Clinical use of cefpirome warrants increased caution, particularly in elderly patients.
• Comprehensive patient evaluation is essential for safe and effective fourth-generation cephalosporin selection.