TY - JOUR
T1 - Efficacy and safety of cefepime
T2 - a systematic review and meta-analysis
AU - Yahav, Dafna
AU - Paul, Mical
AU - Fraser, Abigail
AU - Sarid, Nadav
AU - Leibovici, Leonard
N1 - Funding Information:
These are described in detail in the Methods section on page 338. Conflict of interests We declare we have no conflicts of interests. Acknowledgments DY and MP contributed equally to the manuscript. We thank Mina Nishimori for extracting the data from studies in Japanese, and all investigators who provided supplemental data. We thank the Cochrane Anaesthesia Review Group and the Cochrane Gynaecological Cancer Group for their revision of our protocol and for obtaining and translating several studies. This Review was supported in part by an EC 5th framework IST grant (TREAT project, grant no. 1999-11459). The funding source had no role in study design, collection, analysis, and interpretation of data, writing of the report, or the decision to submit it for publication. Results for patients with febrile neutropenia are included in a systematic review assessing empirical monotherapy for febrile neutropenia, 12 and the results formed the reason for the current Review. This study was presented in part at the 16th European Congress of Clinical Microbiology and Infectious Diseases; April 1–4, 2006; Nice, France (abstract O156). The protocol is published in the Cochrane Library, where this Review will be published and updated. 105
PY - 2007/5
Y1 - 2007/5
N2 - Cefepime is a broad-spectrum cephalosporin with enhanced coverage against Gram-positive and Gram-negative bacteria. We did a systematic review of randomised trials that compared cefepime with another β-lactam antibiotic, alone or with the addition of a non-β-lactam antibiotic to both study groups. We searched Central, PubMed, Embase, Lilacs, new US Food and Drug Administration drug applications, conference proceedings, and references of the included studies. Two reviewers independently did the search and data extraction. 57 trials were included. All-cause mortality-the primary outcome-was higher with cefepime than other β-lactams (risk ratio [RR] 1·26 [95% CI 1·08-1·49]). Sensitivity analyses by the trials' methodological quality revealed higher RRs for trials reporting adequate allocation-sequence generation (1·52 [1·20-1·92]) and allocation concealment (1·36 [1·09-1·70]). Baseline risk factors for mortality were similar. No significant differences between groups in treatment failure, superinfection, or adverse events were found. This Review provides evidence and offers possible explanations for increased mortality among patients treated with cefepime in randomised trials.
AB - Cefepime is a broad-spectrum cephalosporin with enhanced coverage against Gram-positive and Gram-negative bacteria. We did a systematic review of randomised trials that compared cefepime with another β-lactam antibiotic, alone or with the addition of a non-β-lactam antibiotic to both study groups. We searched Central, PubMed, Embase, Lilacs, new US Food and Drug Administration drug applications, conference proceedings, and references of the included studies. Two reviewers independently did the search and data extraction. 57 trials were included. All-cause mortality-the primary outcome-was higher with cefepime than other β-lactams (risk ratio [RR] 1·26 [95% CI 1·08-1·49]). Sensitivity analyses by the trials' methodological quality revealed higher RRs for trials reporting adequate allocation-sequence generation (1·52 [1·20-1·92]) and allocation concealment (1·36 [1·09-1·70]). Baseline risk factors for mortality were similar. No significant differences between groups in treatment failure, superinfection, or adverse events were found. This Review provides evidence and offers possible explanations for increased mortality among patients treated with cefepime in randomised trials.
UR - http://www.scopus.com/inward/record.url?scp=34247173928&partnerID=8YFLogxK
U2 - 10.1016/S1473-3099(07)70109-3
DO - 10.1016/S1473-3099(07)70109-3
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C2 - 17448937
AN - SCOPUS:34247173928
SN - 1473-3099
VL - 7
SP - 338
EP - 348
JO - The Lancet Infectious Diseases
JF - The Lancet Infectious Diseases
IS - 5
ER -
