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Cefepime Efficacy and Safety in Children: A Systematic Review and Meta-analysis

Saber Jan1,2, Braveen Ragunanthan3, Sandra R DiBrito4

  • 1Division of Pediatric Neurology, Department of Pediatrics The Hospital for Sick Children, Toronto, ON, Canada.

Frontiers in Pediatrics
|March 22, 2018
PubMed

Insights

Cefepime (a fourth-generation cephalosporin) showed no significant difference in efficacy or mortality compared to other antibiotics in children. Further research is needed due to study limitations and unclear safety data in pediatric patients.

Area of Science:

  • Pediatric Infectious Diseases
  • Antibiotic Efficacy and Safety
  • Pharmacology

Background:

  • Cefepime, a fourth-generation cephalosporin, is approved for pediatric infections.
  • Existing data on cefepime's efficacy and safety in children are inconsistent.
  • This review addresses the need for clarity on cefepime use in pediatric populations.

Purpose of the Study:

  • To compare the efficacy and all-cause mortality of cefepime versus other antibiotics in pediatric patients.
  • To evaluate secondary outcomes including treatment success, failure, and adverse events.
  • To synthesize current evidence on cefepime's clinical utility in children.

Main Methods:

  • Systematic search of multiple databases (MEDLINE, EMBASE, CENTRAL, LILACS, clinicaltrials.gov) up to February 2016.
  • Inclusion of randomized controlled trials (RCTs) in pediatric patients (0-19 years) with infections.
  • Primary outcome: all-cause mortality; Secondary outcomes: success rate, treatment failure, adverse events. Assessed study quality using Cochrane Risk of Bias.

Main Results:

  • Seventeen studies with 1,285 participants (624 cefepime, 661 comparator) were included.
  • Meta-analysis revealed no significant difference in all-cause mortality (RR 0.88; 95% CI: 0.71-1.08).
  • No significant differences observed in success rates (RR 0.98; 95% CI: 0.92-1.05) or treatment failure (RR 1.04; 95% CI: 0.91-1.19). Adverse events were not statistically assessed due to heterogeneity.

Conclusions:

  • The efficacy and safety of cefepime in pediatric patients remain uncertain.
  • High heterogeneity and methodological flaws limit the current evidence base.
  • Despite recent trials, a decade after the last review, clarity on cefepime's role in pediatric care is still lacking.
Abstract

Keywords:
antibioticcefepimecephalosporinchildrenefficacysafety

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