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Cefepime as treatment for osteomyelitis and other severe bacterial infections
L Jauregui1, D Matzke, M Scott
1Division of Infectious Diseases, St. Vincent Medical Center, Toledo, OH 43608.
Abstract:
Cefepime, a novel, injectable alpha-methoxyimino aminothiazolyl cephalosporin, is active in vitro against many of the Gram-positive and Gram-negative bacteria which cause severe infections, including Pseudomonas aeruginosa. It is more active than existing third-generation cephalosporins against multiply-resistant strains of Enterobacteriaceae because of its low affinity for beta-lactamases and its resistance to hydrolysis by these enzymes. Cefepime retains its high potency of activity against methicillin-susceptible Staphylococcus aureus, coagulase-negative staphylococci and streptococci other than enterococci. Seventy-four patients (46 male and 28 female) were treated with cefepime 2 g i.v. every 12 h; 61 patients were evaluable for efficacy (39 male and 22 female). The infections included pneumonia caused by Gram-negative bacilli (21 patients, six with bacteraemia), septicaemia (seven), pyelonephritis (two), osteomyelitis (23, mainly caused by S. aureus), septic arthritis (four) and soft tissue infections (four, one with bacteraemia). Responses were as follows: 52 (85.3%) patients cured; three (4.9%) improved and six (9.8%) failed. The failures included three patients with osteomyelitis, one with pyelonephritis and two with pneumonia. The pathogens and eradication rates were: S. aureus 23/24 (96%), Staphylococcus epidermidis 4/4, Streptococcus spp. 10/10 (100%), P. aeruginosa 11/14 (79%), Enterobacteriaceae 28/28 (100%), Haemophilus spp. 3/3 and others 7/7. Clinical adverse effects included diarrhoea in 11 patients (14.9%) nausea in five (6.8%) and pruritus in three (4.1%). Laboratory abnormalities included leucopenia in three patients (4.1%) and direct Coombs' conversion in 32 (43.2%). Patients were treated for an average of 31.8 days for osteomyelitis and 11.9 days for other infections.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Cefepime demonstrates high efficacy in treating severe Gram-positive and Gram-negative bacterial infections, including those caused by Pseudomonas aeruginosa and resistant Enterobacteriaceae. This novel cephalosporin offers a potent treatment option with a favorable clinical response rate in diverse infections.
Area of Science:
- Pharmacology
- Infectious Diseases
- Clinical Microbiology
Background:
- Cefepime is a novel alpha-methoxyimino aminothiazolyl cephalosporin with broad-spectrum in vitro activity.
- It exhibits enhanced activity against multiply-resistant Enterobacteriaceae due to low affinity for beta-lactamases.
- Cefepime maintains potency against methicillin-susceptible Staphylococcus aureus and other Gram-positive cocci.
Purpose of the Study:
- To evaluate the clinical efficacy and safety of cefepime in patients with severe bacterial infections.
- To assess the pathogen eradication rates associated with cefepime treatment.
Main Methods:
- A clinical trial involving 74 patients treated with cefepime (2 g i.v. every 12 h).
- Efficacy was evaluated in 61 patients with various infections, including pneumonia, septicaemia, and osteomyelitis.
- Pathogen eradication rates and clinical adverse effects were monitored.
Main Results:
- An overall cure rate of 85.3% was observed in evaluable patients.
- High eradication rates were achieved for Enterobacteriaceae (100%), Streptococcus spp. (100%), and S. aureus (96%).
- Adverse effects included diarrhea (14.9%) and nausea (6.8%); leucopenia and direct Coombs' conversion were also noted.
Conclusions:
- Cefepime is an effective and well-tolerated treatment for severe Gram-positive and Gram-negative bacterial infections.
- Its activity against resistant pathogens makes it a valuable therapeutic option.
- Further investigation into its use for complex infections like osteomyelitis may be warranted.